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Impact on mid-term kidney graft outcomes of pretransplant anti-HLA antibodies detected by solid-phase assays: Do donor-specific antibodies tell the whole story?
- Source :
- Human immunology. 78(9)
- Publication Year :
- 2017
-
Abstract
- The detrimental impact of preformed anti-HLA donor-specific antibodies (DSA) is well defined, contrarily to non-donor-specific antibodies (NDSA). We sought to evaluate their clinical impact in a cohort of 724 kidney graft recipients in whom anti-HLA antibodies were thoroughly screened and identified in pre-transplant sera by solid-phase assays. NDSA or DSA were detected in 100 (13.8%) and 47 (6.5%) recipients respectively, while 577 (79.7%) were non-allosensitized (NaS). Incidence of antibody-mediated rejection at 1-year was 0.7%, 4.0% and 25.5% in NaS, NDSA and DSA patients, respectively (NaS vs. NDSA P=0.004; NaS vs. DSA P0.001; NDSA vs. DSA P0.001). Graft survival was lowest in DSA (78.7%), followed by NDSA (88.0%) and NaS (93.8%) recipients (NaS vs. NDSA P=0.015; NaS vs. DSA P0.001; NDSA vs. DSA P=0.378). Multivariable competing risk analysis confirmed both NDSA (sHR=2.19; P=0.025) and DSA (sHR=2.87; P=0.012) as significant predictors of graft failure. The negative effect of NDSA and DSA on graft survival was significant in patients receiving no induction (P=0.019) or an anti-IL-2 receptor antibody (P0.001), but not in those receiving anti-thymocyte globulin (P=0.852). The recognition of the immunological risk associated with preformed DSA but also NDSA have important implications in patients' risk stratification, and may impact clinical decisions at transplant.
- Subjects :
- Adult
Graft Rejection
Male
medicine.medical_specialty
Immunology
030232 urology & nephrology
Human leukocyte antigen
030230 surgery
Gastroenterology
Cohort Studies
03 medical and health sciences
0302 clinical medicine
HLA Antigens
Isoantibodies
Internal medicine
Immunology and Allergy
Medicine
Humans
Transplantation, Homologous
Hla antibodies
Kidney transplantation
Immunosorbent Techniques
Retrospective Studies
Kidney
biology
business.industry
Incidence (epidemiology)
Donor specific antibodies
Histocompatibility Testing
Graft Survival
General Medicine
Middle Aged
medicine.disease
Kidney Transplantation
Microspheres
body regions
medicine.anatomical_structure
Treatment Outcome
Immunoglobulin G
Cohort
biology.protein
Female
Antibody
business
Subjects
Details
- ISSN :
- 18791166
- Volume :
- 78
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- Human immunology
- Accession number :
- edsair.doi.dedup.....866d3a3076db80e9006c3db38f567992