Pretransplant C3D-fixing donor-specific anti-HLA antibodies are not associated with increased risk for kidney graft failure
Kamburova, Elena G.; Wisse, Bram W.; Joosten, Irma; Allebes, Wil A.; Van Der Meer, Arnold; Hilbrands, Luuk B.; Baas, Marije C.; Spierings, Eric; Hack, Cornelis E.; Van Reekum, Franka E.; Van Zuilen, Arjan D.; Verhaar, Marianne C.; Bots, Michiel L.; Drop, Adriaan C.A.D.; Plaisier, Loes; Seelen, Marc A.J.; Sanders, Jan Stephan; Hepkema, Bouke G.; Lambeck, Annechien J.A.; Bungener, Laura B.; Roozendaal, Caroline; Tilanus, Marcel G.J.; Voorter, Christina E.; Wieten, Lotte; Van Duijnhoven, Elly M.; Gelens, Mariëlle A.C.J.; Christiaans, Maarten H.L.; Van Ittersum, Frans J.; Nurmohamed, Shaikh A.; Lardy, Neubury M.; Swelsen, Wendy; Van Der Pant, Karlijn A.M.I.; Van Der Weerd, Neelke C.; Ten Berge, Ineke J.M.; Bemelman, Frederike J.; Hoitsma, Andries J.; Van Der Boog, Paul J.M.; De Fijter, Johan W.; Betjes, Michiel G.H.; Heidt, Sebastiaan; Roelen, Dave L.; Claas, Frans H.; Otten, Henny G.
(2018) Journal of the American Society of Nephrology, volume 29, issue 9, pp. 2279 - 2285
(Article)
Abstract
Background Complement-fixing antibodies against donor HLA are considered a contraindication for kidney transplant. A modification of the IgG single-antigen bead (SAB) assay allows detection of anti-HLA antibodies that bind C3d. Because early humoral graft rejection is considered to be complement mediated, this SAB-based technique may provide a valuable tool in
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the pretransplant risk stratification of kidney transplant recipients. Methods Previously, we established that pretransplant donor-specific anti-HLA antibodies (DSAs) are associated with increased risk for long-term graft failure in complement-dependent cytotoxicity crossmatch-negative transplants. In this study, we further characterized the DSA-positive serum samples using the C3d SAB assay. Results Among 567 pretransplant DSA-positive serum samples, 97 (17%) contained at least one C3d-fixing DSA, whereas 470 (83%) had non-C3d-fixing DSA. At 10 years after transplant, patients with C3d-fixing antibodies had a death-censored, covariate-adjusted graft survival of 60%, whereas patients with non-C3d-fixing DSA had a graft survival of 64% (hazard ratio, 1.02; 95% confidence interval, 0.70 to 1.48 for C3d-fixing DSA compared with non-C3d-fixing DSA; P50.93). Patients without DSA had a 10-year graft survival of 78%. Conclusions The C3d-fixing ability of pretransplant DSA is not associated with increased risk for graft failure.
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Keywords: Nephrology
ISSN: 1046-6673
Publisher: American Society of Nephrology
Note: Publisher Copyright: Copyright © 2018 by the American Society of Nephrology.
(Peer reviewed)