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Transplantation. 2014 May 29. [Epub ahead of print]

De Novo Donor-Specific Human Leukocyte Antigen Antibodies Early After Kidney Transplantation.

Author information

  • 11 Department of Medicine, Mayo Clinic, Phoenix, AZ. 2 Department of Pathology and Laboratory Medicine, Mayo Clinic, Phoenix, AZ. 3 Department of Surgery, Mayo Clinic, Phoenix, AZ. 4 Address correspondence to: Raymond L. Heilman, M.D., Department of Medicine, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ 85054.

Abstract

BACKGROUND:

Our aim was to determine the incidence of de novo donor-specific human leukocyte antigen (HLA) antibody (dnDSA) during the first year after kidney transplantation and the impact of early dnDSA on acute rejection and protocol biopsy findings.

METHODS:

We selected all patients who received a kidney transplant at our center between July 2010 and March 2012. Single antigen bead assay was performed at 1, 4 and 12 months after transplantation. Only DSAs with a mean fluorescence intensity (MFI) of greater 999 were included.

RESULTS:

We included 245 kidney transplant recipients who did not have a DSA before transplantation. At 12 months, 8.2% of the patients developed dnDSA; 2.4% of them were to HLA class I and 6.5% to HLA class II. Of the 32 patients with a dnDSA at 1 or 4 months, only 8 (25%) persisted at 12 months. The risk of antibody-mediated rejection (AMR) was higher in the dnDSA group. For the dnDSA group with MFI of 3,000 or greater (compared with the group with MFI<3,000), the hazard ratio for AMR was 10.6 (95% confidence interval, 2.27-49.5). The cumulative incidence of AMR or mixed rejection at 1 year was 30% in the group with dnDSA MFI level of 3,000 or greater but only 4% for the group with dnDSA with MFI less than 3,000. On 1-year protocol biopsies, the dnDSA group showed more interstitial inflammation, tubulitis, and glomerulitis.

CONCLUSION:

We conclude that dnDSA occurring during the first posttransplantation year may be transient, and the risk of AMR is higher in patients with a dnDSA MFI level that is greater than 3,000.

PMID:
24879384
[PubMed - as supplied by publisher]
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