title: Pretransplant donor-specific antibodies detected by single-antigen bead flow cytometry are associated with inferior kidney transplant outcomes.
abstract: BACKGROUND
  The clinical significance of pretransplant donor-specific antibodies (pre-Tx DSAs) detected by single-antigen bead flow cytometry (SAB-FC) remains unclear.
  
  
  METHODS
  To investigate the impact that pre-Tx DSAs detected by SAB-FC have on early clinical outcomes, we tested pre-Tx sera from all consecutive deceased-donor kidney transplants performed between January 2005 and July 2006 (n=237).
  
  
  RESULTS
  In the study population of which 66% had a high-immunologic risk, mean fluorescence intensity (MFI) more than or equal to 100 for class I and more than or equal to 200 for class II were the lowest DSA thresholds associated with inferior antibody-mediated rejection-free graft survival (75% vs. 90%, P=0.004 and 76% vs. 87%, P=0.017, respectively). The hazard ratio for antibody-mediated rejection increased linearly with higher class II DSA from MFI 100 to 800 (1.7[0.8-3.2], P=0.1 for MFI ≥100 vs. 4.7[2.4-8.8], P<0.001 for MFI ≥ 800). Differences in graft function were only evident in patients with class II MFI more than or equal to 500 (estimated glomerular filtration rate: 47.6 vs. 54.3, P=0.02 and proteinuria: 0.6 ± 0.6 vs. 0.4 ± 0.3, P=0.03). A difference in death-censored graft survival was detected in patients with class II MFI more than or equal to 1000 (75% vs. 91.9%, P=0.055).
  
  
  CONCLUSIONS
  High-pre-Tx DSAs detected by SAB-FC are associated with incrementally poor graft outcomes in deceased-donor kidney transplant with high-immunologic risk.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Singh
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
authors.forename: David
authors.initials: D
authors.lastname: Lorentzen
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.forename: Nikole
authors.initials: N
authors.lastname: Neidlinger
authors.forename: Barbara
authors.initials: B
authors.lastname: Voss
authors.forename: Jose R
authors.initials: JR
authors.lastname: Torrealba
authors.forename: R Michael
authors.initials: RM
authors.lastname: Hofmann
authors.forename: Jon
authors.initials: J
authors.lastname: Odorico
authors.forename: Luis A
authors.initials: LA
authors.lastname: Fernandez
authors.forename: Hans W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: Milagros
authors.initials: M
authors.lastname: Samaniego
mesh_terms: D000328:Adult; D000918:Antibody Specificity; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies