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.
Highlights
Background. e presence of donor-specific antibodies (DSAs) against HLA before kidney transplantation has been variably associated with decreased long-term graft survival
DSApos recipients received relatively more frequently a deceased donor kidney compared to the DSAneg recipients (58.8% vs. 44.1%) and had a significantly different male/female ratio in both the recipients and kidney donors. e mean total number of HLA mismatches was similar for recipients of living or a deceased donor kidney. e average number of DSA’s per individual was 1.3 ± 0.08, the maximum MFI of DSA 7320 ± 4612, and the cumulative MFI of DSA 8206 ± 5092
Multivariable analysis showed that age of donor, recipient age, and the interaction term for pretransplant DSA and donor type were significantly associated with the longterm risk of graft failure (Table 5). e type of DSA was not significantly related to the incidence of ABMR-related graft loss
Summary
E 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. E 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). 1. Introduction e presence of donor-specific antibodies (DSAs) against HLA molecules is a risk factor for humoral rejection after kidney transplantation. Data on longterm biopsy proven rejection and cause of graft failure defined by renal biopsy, in relation to pretransplant DSA, are lacking. Statistical analysis was performed with software IBM SPSS statistics 21
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