Pretransplant Donor-Specific Anti-HLA Antibodies and the Risk for Rejection-Related Graft Failure of Kidney Allografts

Michiel G H Betjes, Kasia S Sablik, Henny G Otten, Dave L Roelen, Frans H Claas, Annelies de Weerd, Michiel G H Betjes, Kasia S Sablik, Henny G Otten, Dave L Roelen, Frans H Claas, Annelies de Weerd

Abstract

Background: The presence of donor-specific antibodies (DSAs) against HLA before kidney transplantation has been variably associated with decreased long-term graft survival. Data on the relation of pretransplant DSA with rejection and cause of graft failure in recipients of donor kidneys are scarce.

Methods: Patients transplanted between 1995 and 2005 were included and followed until 2016. Donor-specific antibodies before transplantation were determined retrospectively. For cause, renal transplant biopsies were reviewed.

Results: Pretransplant DSAs were found in 160 cases on a total of 734 transplantations (21.8%). In 80.5% of graft failures, a diagnostic renal biopsy was performed. The presence of pretransplant DSA (DSApos) increased the risk of graft failure within the first 3 months after transplantation (5.2% vs. 9.4%) because of rejection with intragraft thrombosis (p < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos, p < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos, p < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos.

Conclusions: Pretransplant DSAs are a risk factor for early graft loss and increase the incidence for humoral rejection and graft loss but do not affect the risk for T cell-mediated rejection.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Michiel G. H. Betjes et al.

Figures

Figure 1
Figure 1
Kaplan–Meier analysis of graft survival censored for death within the first year after transplantation (a) of recipients with or without pretransplantation of donor-specific anti-HLA antibodies (DSA). (b, c) show the cumulative hazard of antibody-mediated rejection (ABMR) and T cell-mediated rejection (TCMR) for recipients within the first year after transplantation according to their status of pretransplant DSA (present or absent). p values are obtained by the log rank test statistics pairwise over strata.
Figure 2
Figure 2
Kaplan–Meier analysis of the cumulative hazard for antibody-mediated rejection (ABMR) and T cell-mediated rejection (TCMR) after the first year after transplantation according to their status of pretransplantation donor-specific anti-HLA antibodies (DSA present or absent). p values are obtained by log rank test statistics pairwise over strata.
Figure 3
Figure 3
Kaplan–Meier analysis of graft survival censored for death after the first year after transplantation (a). Graft loss because of antibody-mediated rejection (ABMR) or T cell-mediated rejection (TCMR) is shown in b and c. Separate survival curves are made for recipients with or without pretransplantation donor-specific anti-HLA antibodies (DSA present or absent). p values are obtained by log rank test statistics pairwise over strata.

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Source: PubMed

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