title: Post-transplant DSA monitoring may predict antibody-mediated rejection in sensitized kidney transplant recipients.
abstract: We examined whether changes in posttransplant highest intensity donor specific anti-HLA antibody specificity (DSAmax) measured by single antigen bead via Luminex (One Lambda, Inc.) were associated with antibody-mediated rejection (AMR). We conducted a retrospective analysis examining risk factors for AMR in 116 consecutive patients who underwent desensitization between 1/1/2009 and 9/1/2010. All patients had a negative flow cytometry crossmatch. The mean patient age at transplant was 46.4 +/- 4 years. The mean peak PRA (panel reactive antibody) and DSAmax at transplant were 40 +/- 6% and 894 +/- 150 mean fluorescent intensity (MFI), respectively. The mean time to rejection was 1.5 +/- 0.4 months. Cox regression analyses demonstrated that an increase in DSAmax by one week after transplant was significantly associated with AMR (pure or mixed). A rise in DSAmax greater than 500 MFI at 1 week was associated with a 2.6 times greater risk of rejection (HR 2.6, 95% CI 1.1 - 6.3, p = 0.02). We conclude that a rise in DSAmax at one week is an independent risk factor forAMR and that posttransplant DSA monitoring strategies may reduce the risk of AMR in sensitized patients.
authors: Departments of Medicine, University of Wisconsin, Madison School of Medicine and Public Health, Madison, Wisconsin, USA. mmohamed@medicine.wisc.edu
authors: Maha A
authors: MA
authors: Mohamed
authors: Brenda
authors: B
authors: Muth
authors: Vijay
authors: V
authors: Vidyasagar
authors: David
authors: D
authors: Foley
authors: Luis
authors: L
authors: Fernandez
authors: R Michael
authors: RM
authors: Hofmann
authors: Josh
authors: J
authors: Mezrich
authors: John
authors: J
authors: Pirsch
authors: Jon
authors: J
authors: Odorico
authors: Tony
authors: T
authors: d'Alessandro
authors: Janet
authors: J
authors: Bellingham
authors: Jose
authors: J
authors: Torrealba
authors: Dixon
authors: D
authors: Kaufman
authors: Arjang
authors: A
authors: Djamali
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D003888:Desensitization, Immunologic; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000379:methods; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014922:Wisconsin
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens; D007166:Immunosuppressive Agents