title: Baseline donor-specific antibody levels and outcomes in positive crossmatch kidney transplantation.
abstract: Renal transplant candidates with donor-specific alloantibody (DSA) have increased risk of antibody-mediated allograft injury. The goal of this study was to correlate the risk of antibody-mediated rejection (AMR), transplant glomerulopathy (TG) and graft survival with the baseline DSA level (prior to initiation of pretransplant conditioning). These analyses include 119 positive crossmatch (+XM) compared to 70 negative crossmatch (-XM) transplants performed between April 2000 and July 2007. Using a combination of cell-based crossmatch tests, DSA level was stratified into very high +XM, high +XM, low +XM and -XM groups. In +XM transplants, increasing DSA level was associated with increased risk for AMR (HR = 1.76 [1.51, 2.07], p = 0.0001) but not TG (p = 0.18). We found an increased risk for both early and late allograft loss associated with very high DSA (HR = 7.71 [2.95, 20.1], p = 0.0001). Although lower DSA recipients commonly developed AMR and TG, allograft survival was similar to that of -XM patients (p = 0.31). We conclude that the baseline DSA level correlates with risk of early and late alloantibody-mediated allograft injury. With current protocols, very high baseline DSA patients have high rates of AMR and poor long-term allograft survival highlighting the need for improved therapy for these candidates.
authors.affiliation: Division of Nephrology and Hypertension and Transplant Center, Department of Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA. gloor.james@mayo.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Gloor
authors.forename: J L
authors.initials: JL
authors.lastname: Winters
authors.forename: L D
authors.initials: LD
authors.lastname: Cornell
authors.forename: L A
authors.initials: LA
authors.lastname: Fix
authors.forename: S R
authors.initials: SR
authors.lastname: DeGoey
authors.forename: R M
authors.initials: RM
authors.lastname: Knauer
authors.forename: F G
authors.initials: FG
authors.lastname: Cosio
authors.forename: M J
authors.initials: MJ
authors.lastname: Gandhi
authors.forename: W
authors.initials: W
authors.lastname: Kremers
authors.forename: M D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies