title: The impact of pretransplant donor-specific antibodies on graft outcome in renal transplantation: a six-year follow-up study.
abstract: OBJECTIVE
  The significance of pretransplant, donor-specific antibodies on long-term patient outcomes is a subject of debate. This study evaluated the impact and the presence or absence of donor-specific antibodies after kidney transplantation on short- and long-term graft outcomes.
  
  
  METHODS
  We analyzed the frequency and dynamics of pretransplant donor-specific antibodies following renal transplantation from a randomized trial that was conducted from 2002 to 2004 and correlated these findings with patient outcomes through 2009. Transplants were performed against a complement-dependent T- and B-negative crossmatch. Pre- and posttransplant sera were available from 94 of the 118 patients (80%). Antibodies were detected using a solid-phase (Luminex®), single-bead assay, and all tests were performed simultaneously.
  
  
  RESULTS
  Sixteen patients exhibited pretransplant donor-specific antibodies, but only 3 of these patients (19%) developed antibody-mediated rejection and 2 of them experienced early graft losses. Excluding these 2 losses, 6 of 14 patients exhibited donor-specific antibodies at the final follow-up exam, whereas 8 of these patients (57%) exhibited complete clearance of the donor-specific antibodies. Five other patients developed ''de novo'' posttransplant donor-specific antibodies. Death-censored graft survival was similar in patients with pretransplant donor-specific and non-donor-specific antibodies after a mean follow-up period of 70 months.
  
  
  CONCLUSIONS
  Pretransplant donor-specific antibodies with a negative complement-dependent cytotoxicity crossmatch are associated with a risk for the development of antibody-mediated rejection, although survival rates are similar when patients transpose the first months after receiving the graft. Our data also suggest that early posttransplant donor-specific antibody monitoring should increase knowledge of antibody dynamics and their impact on long-term graft outcome.
authors.affiliation: Renal Transplantation Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. elias.david.neto@attglobal.net
authors.forename: Elias
authors.initials: E
authors.lastname: David-Neto
authors.forename: Patricia Soares
authors.initials: PS
authors.lastname: Souza
authors.forename: Nicolas
authors.initials: N
authors.lastname: Panajotopoulos
authors.forename: Helcio
authors.initials: H
authors.lastname: Rodrigues
authors.forename: Carlucci Gualberto
authors.initials: CG
authors.lastname: Ventura
authors.forename: Daisa Silva Ribeiro
authors.initials: DS
authors.lastname: David
authors.forename: Francine Brambate Carvalhinho
authors.initials: FB
authors.lastname: Lemos
authors.forename: Fabiana
authors.initials: F
authors.lastname: Agena
authors.forename: William Carlos
authors.initials: WC
authors.lastname: Nahas
authors.forename: Jorge Elias
authors.initials: JE
authors.lastname: Kalil
authors.forename: Maria Cristina Ribeiro
authors.initials: MC
authors.lastname: Castro
mesh_terms: D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000276:immunology*; D001788:Blood Grouping and Crossmatching; D003430:Cross-Sectional Studies; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus