Donor-specific antibodies in kidney deceased donor transplantation

Abstract

Aim Pre-sensitization against a broad array of HLA is associated with prolonged waiting times and inferior kidney allograft survival. Although the use of solid phase assay (SPA) for the detection and characterization of anti-HLA antibodies provides greater sensitivity than complement-dependent lymphocytotoxicity (CDC) assay, it often detects donor specific antibodies (DSA) which turn out to be clinically irrelevant. In this study, our aim is to determine whether kidney deceased donor recipients with preformed DSA detectable in serum obtained prior to transplant are at an increased risk of graft failure. Methods We studied 640 patients who received a kidney transplant from a deceased donor between January 1, 2009 and December 31, 2014 at Columbia University Medical Center. Sera collected from the recipients prior to transplantation were tested for DSA by CDC and SPA with single antigen coated beads. All patients were transplanted with negative CDC crossmatch. Results We analyzed the actuarial graft survival in patients with a primary allograft ( n = 525) and in patients with a secondary allograft ( n = 115). Kidney allograft survival was significantly higher in primary allograft recipients (85%) than in secondary allograft recipients (71%) at 6 years. ( P = 0.02) Forty-six out of 525 (8.7%) primary kidney allograft recipients and sixty-two out of 115 (53.9%) secondary kidney allograft recipients had SPA-detectable DSA in sera collected prior to transplantation. Six years following transplantation of primary kidney allografts the actuarial graft survival was 83% and 85%, respectively, regardless of whether DSA were detectable in recipients’ pre-transplantation sera. ( P = 0.39) In recipients of secondary kidney allografts with and without SPA-detectable DSA, the actuarial graft survival was 67% and 77% at 6 years, respectively. ( P = 0.12) Conclusions The presence of SPA-detectable DSA in recipients of kidney allografts from deceased donors is associated with lower long term (6 year) actuarial graft survival although the difference does not reach statistical significance.