Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant
Kamburova, E. G.; Wisse, B. W.; Joosten, I.; Allebes, W. A.; van der Meer, A.; Hilbrands, L. B.; Baas, M. C.; Spierings, E.; Hack, C. E.; van Reekum, F. E.; van Zuilen, A. D.; Verhaar, M. C.; Bots, M. L.; Drop, A. C.A.D.; Plaisier, L.; Seelen, M. A.J.; Sanders, J. S.F.; Hepkema, B. G.; Lambeck, A. J.A.; Bungener, L. B.; Roozendaal, C.; Tilanus, M. G.J.; Voorter, C. E.; Wieten, L.; van Duijnhoven, E. M.; Gelens, M.; Christiaans, M. H.L.; van Ittersum, F. J.; Nurmohamed, S. A.; Lardy, N. M.; Swelsen, W.; van der Pant, K. A.; van der Weerd, N. C.; ten Berge, I. J.M.; Bemelman, F. J.; Hoitsma, A.; van der Boog, P. J.M.; de Fijter, J. W.; Betjes, M. G.H.; Heidt, S.; Roelen, D. L.; Claas, F. H.; Otten, H. G.
(2018) American Journal of Transplantation, volume 18, issue 9, pp. 2274 - 2284
(Article)
Abstract
The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the
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impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.
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Keywords: Alloantibody, Clinical research/practice, Graft survival, Kidney failure/injury, Kidney transplantation, Kidney transplantation/nephrology, Living donor, Immunology and Allergy, Transplantation, Pharmacology (medical)
ISSN: 1600-6135
Publisher: Elsevier
Note: Publisher Copyright: © 2018 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons
(Peer reviewed)
