title: A report of the epidemiology of de novo donor-specific anti-HLA antibodies (DSA) in "low-risk" renal transplant recipients.
abstract: The donor specific anti-HLA antibody (DSA) has been increasingly recognized as the major cause of allograft loss. Despite this, no published reports exist describing the true epidemiology of de novo DSA.Here we describe the epidemiology of DSA based on the results of one of the longest running antibody study in consecutive renal transplant recipients. The study includes 224 non-sensitized, non-HLA-identical patients who received a primary kidney transplant between 3/1999-3/2006. Protocol testing for DSA was done pre-transplant, at 1, 3, 6, 9, and 12 months, and then annually. DSA was tested using single antigen beads. Data from the East Carolina University transplant cohort indicate that the prevalence of DSA in the first year post-transplant is 12.1 cases per 100. The average annual incidence of DSA is 4.7 per 100 cases, per year. The highest incidence of DSA was in the first year post transplant. Although deceased donors and African-Americans have a higher incidence rate of DSA than the comparator living donors and non-African American groups, respectively, these factors were not associated with DSA onset. The one factor found to be predictive of DSA was DQ mismatch (p = 0.036). Based on these epidemiologic findings in combination with previous reports showing DSA is a cause of allograft failure, it seems reasonable that at least annual testing should be done even in "low-risk" transplant patients, because every year a new 5% of patients will develop DSA.
authors: Department of Pathology, Brody School of Medicine at ECU, Greenville, NC, USA. rebellatol@ecu.edu
authors: Lorita M
authors: LM
authors: Rebellato
authors: Mathew J
authors: MJ
authors: Everly
authors: Carl E
authors: CE
authors: Haisch
authors: Miyuki
authors: M
authors: Ozawa
authors: Kimberly P
authors: KP
authors: Briley
authors: Karen
authors: K
authors: Parker
authors: Paul G
authors: PG
authors: Catrou
authors: Paul
authors: P
authors: Bolin
authors: William T
authors: WT
authors: Kendrick
authors: Scott A
authors: SA
authors: Kendrick
authors: Robert C
authors: RC
authors: Harland
mesh_terms: D003888:Desensitization, Immunologic; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility / Q000187:drug effects; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D015166:Monitoring, Immunologic; D009657:North Carolina / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D023001:Transplantation Tolerance / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies