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Am J Transplant. 2019 Nov;19(11):3100-3113. doi: 10.1111/ajt.15414. Epub 2019 Jun 19.

Specificity, strength, and evolution of pretransplant donor-specific HLA antibodies determine outcome after kidney transplantation.

Author information

1
Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
2
Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium.
3
Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium.
4
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.

Abstract

In this cohort study (N = 924), we investigated the evolution and clinical significance of pretransplant donor-specific HLA antibodies (preDSA), detected in the single-antigen beads assay but complement-dependent cytotoxicity crossmatch-negative. Donor specificity of the preDSA (N = 107) was determined by high-resolution genotyping of donor-recipient pairs. We found that in 52% of the patients with preDSA, preDSA spontaneously resolved within the first 3 months posttransplant. PreDSA that persisted posttransplant had higher pretransplant median fluorescence intensity values and more specificity against DQ. Patients with both resolved and persistent DSA had a high incidence of histological picture of antibody-mediated rejection (ABMRh ; 54% and 59% respectively). Patients with preDSA that persisted posttransplant had worse 10-year graft survival compared to resolved DSA and preDSA-negative patients. Compared to cases without preDSA, Cox modeling revealed an increased risk of graft failure only in the patients with persistent DSA, in the presence (hazard ratio [HR] = 8.3) but also in the absence (HR = 4.3) of ABMRh . In contrast, no increased risk of graft failure was seen in patients with resolved DSA. We conclude that persistence of preDSA posttransplant has a negative impact on graft survival, beyond ABMRh . Even in the absence of antibody-targeting therapy, low median fluorescence intensity DSA and non-DQ preDSA often disappear early posttransplantation and are not deleterious for graft outcome.

KEYWORDS:

alloantibody; antibody-mediated (ABMR); clinical research/practice; deceased; donors and donation; health services and outcomes research; histocompatibility; kidney transplantation/nephrology; major histocompatibility complex (MHC); organ procurement and allocation; rejection; risk assessment/risk stratification

PMID:
31062492
DOI:
10.1111/ajt.15414

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