Back to Search
Start Over
Determining donor-specific antibody C1q-binding ability improves the prediction of antibody-mediated rejection in human leucocyte antigen-incompatible kidney transplantation
- Source :
- Transplant international : official journal of the European Society for Organ Transplantation. 30(4)
- Publication Year :
- 2016
-
Abstract
- Detrimental impact of preformed donor-specific antibodies (DSAs) against human leucocyte antigens on outcomes after kidney transplantation are well documented, however, the value of their capacity to bind complement for predicting antibody-mediated rejection (AMR) and graft survival still needs to be confirmed. We aimed to study DSA characteristics (strength and C1q binding) that might distinguish harmful DSA from clinically irrelevant ones. We retrospectively studied 60 kidney-transplanted patients with preformed DSA detected by single antigen bead (SAB) assays (IgG and C1q kits), from a cohort of 517 kidney graft recipients (124 with detectable anti-HLA antibodies). Patients were divided into DSA strength (MFI < vs. ≥ 15 000) and C1q-binding ability. AMR frequency was high (30%) and it increased with DSA strength (P = 0.002) and C1q+ DSA (P < 0.001). The performance of DSA C1q-binding ability as a predictor of AMR was better than DSA strength (diagnostic odds ratio 16.3 vs. 6.4, respectively). Furthermore, a multivariable logistic regression showed that C1q+ DSA was a risk factor for AMR (OR = 16.80, P = 0.001), while high MFI DSAs were not. Graft survival was lower in high MFI C1q+ DSA in comparison with patients with C1q- high or low MFI DSA (at 6 years, 38%, 83% and 80%, respectively; P = 0.001). Both DSA strength and C1q-binding ability assessment seem valuable for improving pretransplant risk assessment. Since DSA C1q-binding ability was a better predictor of AMR and correlated with graft survival, C1q-SAB may be a particularly useful tool.
- Subjects :
- Adult
Graft Rejection
Male
medicine.medical_specialty
Human leucocyte antigen
Biopsy
030232 urology & nephrology
chemical and pharmacologic phenomena
030230 surgery
Gastroenterology
03 medical and health sciences
0302 clinical medicine
HLA Antigens
Isoantibodies
Risk Factors
Internal medicine
medicine
Odds Ratio
Humans
Risk factor
Kidney transplantation
Retrospective Studies
Transplantation
Kidney
biology
business.industry
Donor specific antibodies
Complement C1q
Graft Survival
Histocompatibility Antigens Class I
Histocompatibility Antigens Class II
Middle Aged
medicine.disease
Kidney Transplantation
Tissue Donors
body regions
medicine.anatomical_structure
Immunoglobulin G
Antibody mediated rejection
Immunology
Multivariate Analysis
Diagnostic odds ratio
biology.protein
Female
Antibody
business
Algorithms
Subjects
Details
- ISSN :
- 14322277
- Volume :
- 30
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Transplant international : official journal of the European Society for Organ Transplantation
- Accession number :
- edsair.doi.dedup.....2383e860d0c28b14e64dc6af1241b3df