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Nephrol Dial Transplant. 2019 Jun 1;34(6):1056-1063. doi: 10.1093/ndt/gfy316.

A paired kidney analysis on the impact of pre-transplant anti-HLA antibodies on graft survival.

Author information

1
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
2
Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
3
Laboratory Medicine, Lab Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands.
4
Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
5
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
6
Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
7
Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
8
Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands.
9
Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.
10
Department of Nephrology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands.
11
Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands.
12
Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
13
Dutch Organ Transplant Registry (NOTR), Dutch Transplant Foundation (NTS), Leiden, The Netherlands.
14
Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
15
Department of Nephrology, Rotterdam, The Netherlands.
16
Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

BACKGROUND:

Pre-transplant donor-specific anti-human leucocyte antigen (HLA) antibodies (DSAs) are associated with impaired kidney graft survival while the clinical relevance of non-donor-specific anti-HLA antibodies (nDSAs) is more controversial. The aim of the present paired kidney graft study was to compare the clinical relevance of DSAs and nDSAs.

METHODS:

To eliminate donor and era-dependent factors, a post hoc paired kidney graft analysis was performed as part of a Dutch multicentre study evaluating all transplantations between 1995 and 2005 with available pre-transplant serum samples. Anti-HLA antibodies were detected with a Luminex single-antigen bead assay.

RESULTS:

Among 3237 deceased donor transplantations, we identified 115 recipient pairs receiving a kidney from the same donor with one recipient being DSA positive and the other without anti-HLA antibodies. Patients with pre-transplant DSAs had a significantly lower 10-year death-censored graft survival (55% versus 82%, P=0.0001). We identified 192 pairs with one recipient as nDSA positive (against Class I and/or II) and the other without anti-HLA antibodies. For the patients with nDSAs against either Class I or II, graft survival did not significantly differ compared with patients without anti-HLA antibodies (74% versus 77%, P = 0.79). Only in patients with both nDSAs Class I and II was there a trend towards a lower graft survival (58%, P = 0.06). Lastly, in a small group of 42 recipient pairs, 10-year graft survival in recipients with DSAs was 49% compared with 68% in recipients with nDSAs (P=0.11).

CONCLUSION:

This paired kidney analysis confirms that the presence of pre-transplant DSAs in deceased donor transplantations is a risk marker for graft loss, whereas nDSAs in general are not associated with a lower graft survival. Subgroup analysis indicated that only in broadly sensitized patients with nDSAs against Class I and II, nDSAs may be a risk marker for graft loss in the long term.

KEYWORDS:

HLA antibodies; acute rejection; graft survival; immunology; kidney transplantation

PMID:
30365008
DOI:
10.1093/ndt/gfy316

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