TY - JOUR
T1 - A paired kidney analysis on the impact of pre-transplant anti-HLA antibodies on graft survival
AU - Michielsen, Laura A
AU - Wisse, Bram W
AU - Kamburova, Elena G
AU - Verhaar, Marianne C
AU - Joosten, Irma
AU - Allebes, Wil A
AU - van der Meer, Arnold
AU - Hilbrands, Luuk B
AU - Baas, Marije C
AU - Spierings, Eric
AU - Hack, Erik
AU - van Reekum, Franka E
AU - Bots, Michiel L
AU - Drop, Adriaan C A D
AU - Plaisier, Loes
AU - Seelen, Marc A J
AU - Sanders, Jan-Stephan F
AU - Hepkema, Bouke G
AU - Lambeck, Annechien J
AU - Bungener, Laura B
AU - Roozendaal, Caroline
AU - Tilanus, Marcel G J
AU - Voorter, Christien E
AU - Wieten, Lotte
AU - van Duijnhoven, Elizabeth M
AU - Gelens, Mariëlle
AU - Christiaans, Maarten H L
AU - van Ittersum, Frans J
AU - Nurmohamed, Shaikh A
AU - Lardy, Neubury M
AU - Swelsen, Wendy
AU - van der Pant, Karlijn A
AU - van der Weerd, Neelke C
AU - Ten Berge, Ineke J M
AU - Bemelman, Frederike J
AU - Hoitsma, Andries
AU - van der Boog, Paul J M
AU - de Fijter, Johan W
AU - Betjes, Michiel G H
AU - Heidt, Sebastiaan
AU - Roelen, Dave L
AU - Claas, Frans H
AU - Otten, Henderikus G
AU - van Zuilen, Arjan D
N1 - © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background: Pre-transplant donor-specific anti-human leucocyte antigen (HLA) antibodies (DSAs) are associated with impaired kidney graft survival while the clinical relevance of non-donor-specific anti-HLA antibodies (nDSAs) is more controversial. The aim of the present paired kidney graft study was to compare the clinical relevance of DSAs and nDSAs.Methods: To eliminate donor and era-dependent factors, a post hoc paired kidney graft analysis was performed as part of a Dutch multicentre study evaluating all transplantations between 1995 and 2005 with available pre-transplant serum samples. Anti-HLA antibodies were detected with a Luminex single-antigen bead assay.Results: Among 3237 deceased donor transplantations, we identified 115 recipient pairs receiving a kidney from the same donor with one recipient being DSA positive and the other without anti-HLA antibodies. Patients with pre-transplant DSAs had a significantly lower 10-year death-censored graft survival (55% versus 82%, P=0.0001). We identified 192 pairs with one recipient as nDSA positive (against Class I and/or II) and the other without anti-HLA antibodies. For the patients with nDSAs against either Class I or II, graft survival did not significantly differ compared with patients without anti-HLA antibodies (74% versus 77%, P = 0.79). Only in patients with both nDSAs Class I and II was there a trend towards a lower graft survival (58%, P = 0.06). Lastly, in a small group of 42 recipient pairs, 10-year graft survival in recipients with DSAs was 49% compared with 68% in recipients with nDSAs (P=0.11).Conclusion: This paired kidney analysis confirms that the presence of pre-transplant DSAs in deceased donor transplantations is a risk marker for graft loss, whereas nDSAs in general are not associated with a lower graft survival. Subgroup analysis indicated that only in broadly sensitized patients with nDSAs against Class I and II, nDSAs may be a risk marker for graft loss in the long term.
AB - Background: Pre-transplant donor-specific anti-human leucocyte antigen (HLA) antibodies (DSAs) are associated with impaired kidney graft survival while the clinical relevance of non-donor-specific anti-HLA antibodies (nDSAs) is more controversial. The aim of the present paired kidney graft study was to compare the clinical relevance of DSAs and nDSAs.Methods: To eliminate donor and era-dependent factors, a post hoc paired kidney graft analysis was performed as part of a Dutch multicentre study evaluating all transplantations between 1995 and 2005 with available pre-transplant serum samples. Anti-HLA antibodies were detected with a Luminex single-antigen bead assay.Results: Among 3237 deceased donor transplantations, we identified 115 recipient pairs receiving a kidney from the same donor with one recipient being DSA positive and the other without anti-HLA antibodies. Patients with pre-transplant DSAs had a significantly lower 10-year death-censored graft survival (55% versus 82%, P=0.0001). We identified 192 pairs with one recipient as nDSA positive (against Class I and/or II) and the other without anti-HLA antibodies. For the patients with nDSAs against either Class I or II, graft survival did not significantly differ compared with patients without anti-HLA antibodies (74% versus 77%, P = 0.79). Only in patients with both nDSAs Class I and II was there a trend towards a lower graft survival (58%, P = 0.06). Lastly, in a small group of 42 recipient pairs, 10-year graft survival in recipients with DSAs was 49% compared with 68% in recipients with nDSAs (P=0.11).Conclusion: This paired kidney analysis confirms that the presence of pre-transplant DSAs in deceased donor transplantations is a risk marker for graft loss, whereas nDSAs in general are not associated with a lower graft survival. Subgroup analysis indicated that only in broadly sensitized patients with nDSAs against Class I and II, nDSAs may be a risk marker for graft loss in the long term.
KW - Journal Article
KW - Acute rejection
KW - Graft survival
KW - Immunology
KW - HLA antibodies
KW - Kidney transplantation
KW - acute rejection
KW - kidney transplantation
KW - graft survival
KW - immunology
UR - http://www.scopus.com/inward/record.url?scp=85067098923&partnerID=8YFLogxK
U2 - 10.1093/ndt/gfy316
DO - 10.1093/ndt/gfy316
M3 - Article
C2 - 30365008
SN - 0931-0509
VL - 34
SP - 1056
EP - 1063
JO - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
IS - 6
ER -