title: Pretransplant donor-specific HLA class-I and -II antibodies are associated with an increased risk for kidney graft failure.
abstract: Pretransplant risk assessment of graft failure is important for donor selection and choice of immunosuppressive treatment. We examined the relation between kidney graft failure and presence of IgG donor specific HLA antibodies (DSA) or C1q-fixing DSA, detected by single antigen bead array (SAB) in pretransplant sera from 837 transplantations. IgG-DSA were found in 290 (35%) sera, whereas only 30 (4%) sera had C1q-fixing DSA. Patients with both class-I plus -II DSA had a 10 yr graft survival of 30% versus 72% in patients without HLA antibodies (p < 0.001). No significant difference was observed in graft survival between patients with or without C1q-fixing DSA. Direct comparison of both assays showed that high mean fluorescence intensity values on the pan-IgG SAB assay are generally related to C1q-fixation. We conclude that the presence of class-I plus -II IgG DSA as detected by SAB in pretransplant sera of crossmatch negative kidney recipients is indicative for an increased risk for graft failure, whereas the clinical significance of C1q-fixing IgG-DSA could not be assessed due to their low prevalence.
authors.affiliation: Department of Immunology, University Medical Center Utrecht, The Netherlands. h.g.otten@umcutrecht.nl
authors.forename: H G
authors.initials: HG
authors.lastname: Otten
authors.forename: M C
authors.initials: MC
authors.lastname: Verhaar
authors.forename: H P E
authors.initials: HP
authors.lastname: Borst
authors.forename: R J
authors.initials: RJ
authors.lastname: Hené
authors.forename: A D
authors.initials: AD
authors.lastname: van Zuilen
mesh_terms: D006084:Graft Rejection; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D000949:Histocompatibility Antigens Class II / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation; D012307:Risk Factors
chemical_list: D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II