Donor-specific antibody levels and three generations of crossmatches to predict antibody-mediated rejection in kidney transplantation.
BACKGROUND
This study evaluated the prognostic impact of pretransplant donor-specific anti-human leukocyte antigen antibodies (DSA) detected by single-antigen beads and compared the three generations of crossmatch (XM) tests in kidney transplantation.


METHODS
Thirty-seven T-cell complement-dependent cytotoxicity crossmatch (CXM) negative living donor kidney recipients with a retrospectively positive antihuman leukocyte antigen antibody screening assay were included. A single-antigen bead test, a flow cytometry XM, and a Luminex XM (LXM) were retrospectively performed, and the results were correlated with the occurrence of antibody-mediated rejections (AMRs) and graft function.


RESULTS
We found that (1) pretransplant DSA against class I (DSA-I), but not against class II, are predictive for AMR, resulting in a sensitivity of 75% and a specificity of 90% at a level of 900 mean fluorescence intensity (MFI); (2) with increasing strength of DSA-I, the sensitivity for AMR is decreasing to 50% and the specificity is increasing to 100% at 5200 MFI; (3) the LXM for class I, but not for class II, provides a higher accuracy than the flow cytometry XM and the B-cell CXM. The specificity of all XMs is increased greatly in combination with DSA-I values more than or equal to 900 MFI.


CONCLUSIONS
In sensitized recipients, the best prediction of AMR and consecutively reduced graft function is delivered by DSA-I alone at high strength or by DSA-I at low strength in combination with the LXM or CXM.
Riethmüller
Sebastian
S
Division of Visceral and Transplant Surgery, University Hospital, Zurich, Switzerland. sebastian.riethmueller@usz.ch
Ferrari-Lacraz
Sylvie
S
Müller
Markus K
MK
Raptis
Dimitri A
DA
Hadaya
Karine
K
Rüsi
Barbara
B
Laube
Guido
G
Schneiter
Gregory
G
Fehr
Thomas
T
Villard
Jean
J
D000328:Adult; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000097:blood / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014019:Tissue Donors
D006680:HLA Antigens; D007518:Isoantibodies