Clinical Relevance of Preformed HLA Donor‐Specific Antibodies in Kidney Transplantation

This study analyzes the influence of preformed DSA, identified by HLA‐specific ELISA assays, on graft survival and evaluates the incidence of antibody‐mediated rejection (AMR) in patients with and without pregraft desensitization. Kidney graft survival at 8 years was significantly worse in patients...

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Bibliographic Details
Published in:American journal of transplantation 2008-02, Vol.8 (2), p.324-331
Main Authors: Lefaucheur, C., Suberbielle‐Boissel, C., Hill, G. S., Nochy, D., Andrade, J., Antoine, C., Gautreau, C., Charron, D., Glotz, D.
Format: Article
Language:English
Subjects:
Algorithms
Antibodies
Antibody‐mediated rejection
Biological and medical sciences
Cadaver
clinical kidney transplantation
Donors
donor‐specific antibodies
Enzyme-Linked Immunosorbent Assay
Female
Graft rejection
Graft Rejection - epidemiology
graft survival
Histocompatibility antigen HLA
Histocompatibility Antigens Class I - immunology
Histocompatibility Testing
Historical account
HLA Antigens - blood
HLA-D Antigens - immunology
Humans
Immunosuppressive Agents - therapeutic use
Isoantibodies - immunology
Kidney
Kidney transplantation
Kidney Transplantation - immunology
Living Donors - statistics & numerical data
Male
Medical sciences
Retrospective Studies
Stratification
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Survival
Tissue Donors - statistics & numerical data
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Summary:This study analyzes the influence of preformed DSA, identified by HLA‐specific ELISA assays, on graft survival and evaluates the incidence of antibody‐mediated rejection (AMR) in patients with and without pregraft desensitization. Kidney graft survival at 8 years was significantly worse in patients with DSA (n = 43) than in those without DSA (n = 194)(p = 0.03). The incidence of AMR in patients with DSA is 9‐fold higher than in patients without DSA (p < 0.001) and their graft survival is significantly worse than in DSA patients without AMR and in non‐DSA patients (p = 0.005). The prevalence for AMR in patients with DSA detected on historic serum is 32.3% in nondesensitized patients and 41.7% in desensitized patients. The risk for AMR is significantly more elevated in patients with strongly positive DSA (score 6–8) compared to those with DSA score 4 (p < 0.001), and in patients with historic DSA+/CXM+ compared to those with DSA+/CXM− (p = 0.01). The presence of preformed DSA is strongly associated with graft loss in kidney transplants, related to an increased risk of AMR. Our findings demonstrate the importance of detection and characterization of DSA before transplantation. Stratification of this risk could be used to determine kidney allocation and to devise specific strategies for these patients. The presence of preformed HLA donor specific antibodies is strongly associated with graft loss in kidney transplants, related to an increased risk of antibody‐mediated rejection.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2007.02072.x