title: Donor-specific HLA antibodies: risk factors and outcomes after kidney transplantation.
abstract: BACKGROUND
  Anti-human leukocyte antigen antibodies (HLA Abs) have been associated with reduced kidney allograft survival. Our aim was to analyze the prevalence and impact on allograft function of donor-specific HLA antibodies (DSA) among a cohort of kidney transplant recipients.
  
  
  METHODS
  The 321 recipients had received deceased-donor kidneys followed for a median of 70 ± 43 months. We performed a cross-sectional analysis of the presence of HLA Abs with the use of Luminex technology.
  
  
  RESULTS
  Fifty patients (15.6%) displayed HLA Abs after transplantation including 21 (6.7%) as de novo HLA Abs. Eight patients (2.5%) developed DSA, and 42 (13%) showed no DSA. We compared 3 groups of patients: with DSA, without DSA, and without HLA sensitization. The DSA patients were younger (P = .03) with a higher percentage of men (P = .00), and having received less frequent induction treatment with basiliximab or thymoglobulin (P = .02). Patients without DSA revealed a higher percentage of pretransplantation HLA sensitization (P = .00), more pretransplantation transfusions (P = .08), and more frequent retransplantations (P = .00). The incidence of acute rejections was higher for DSA patients (P = .02) than for the other 2 groups, behaving as an independent risk factor (relative risk, 4.7; 95% confidence interval, 1.1-18.8; P = .03). Graft survival at 5 years was lower among patients with compared to those without HLA Abs (P = .00).
  
  
  CONCLUSIONS
  HLA donor-specific sensitization, an uncommon situation in our study, was associated with younger male recipients and less induction treatment. An acute rejection episode was an independent risk factor for the development of DSA; therefore, we think that monitoring of HLA Abs should be included in evaluation of the early postransplantation period.
authors.affiliation: Nephrology and Hemodialysis Department, Doctor Peset University Hospital, Valencia, Spain. jkanter@senefro.org
authors.forename: J
authors.initials: J
authors.lastname: Kanter Berga
authors.forename: L M
authors.initials: LM
authors.lastname: Pallardo Mateu
authors.forename: S
authors.initials: S
authors.lastname: Beltran Catalan
authors.forename: N
authors.initials: N
authors.lastname: Puig Alcaraz
authors.forename: A
authors.initials: A
authors.lastname: Sancho Calabuig
authors.forename: E
authors.initials: E
authors.lastname: Gavela Martinez
authors.forename: A
authors.initials: A
authors.lastname: Avila Bernabeu
authors.forename: J
authors.initials: J
authors.lastname: Crespo Albiach
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies