TY - JOUR
T1 - Pretransplant C3D-fixing donor-specific anti-HLA antibodies are not associated with increased risk for kidney graft failure
AU - Kamburova, Elena G.
AU - Wisse, Bram W.
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, Cornelis E.
AU - Van Reekum, Franka E.
AU - Van Zuilen, Arjan D.
AU - Verhaar, Marianne C.
AU - Bots, Michiel L.
AU - Drop, Adriaan C.A.D.
AU - Plaisier, Loes
AU - Seelen, Marc A.J.
AU - Sanders, Jan Stephan
AU - Hepkema, Bouke G.
AU - Lambeck, Annechien J.A.
AU - Bungener, Laura B.
AU - Roozendaal, Caroline
AU - Tilanus, Marcel G.J.
AU - Voorter, Christina E.
AU - Wieten, Lotte
AU - Van Duijnhoven, Elly M.
AU - Gelens, Mariëlle A.C.J.
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.M.I.
AU - Van Der Weerd, Neelke C.
AU - Ten Berge, Ineke J.M.
AU - Bemelman, Frederike J.
AU - Hoitsma, Andries J.
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, Henny G.
N1 - Publisher Copyright:
Copyright © 2018 by the American Society of Nephrology.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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 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.
AB - 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 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.
UR - https://www.scopus.com/pages/publications/85052550574
U2 - 10.1681/ASN.2018020205
DO - 10.1681/ASN.2018020205
M3 - Article
C2 - 30049681
SN - 1046-6673
VL - 29
SP - 2279
EP - 2285
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 9
ER -