title: Significance of low-level DSA detected by solid-phase assay in association with acute and chronic antibody-mediated rejection.
abstract: We sought to clarify the controversial issue of whether detecting low-level anti-donor-specific HLA antibody (HLA-DSA) by single-antigen flow-bead assay (SAFB) may have a potential role in reducing acute and chronic antibody-mediated rejection (AMR). We retrospectively studied the preoperative serum of ABO-compatible living kidney transplantation recipients transplanted between 2001 and 2004 by SAFB using a Luminex platform. HLA-DSA was detected only by SAFB in 24 patients, although all of them showed negative T-cell and B-cell complement-dependent cytotoxicity (CDC) crossmatches. The HLA-DSA patients went on to have surprisingly high levels of acute and chronic AMR despite being only weakly sensitized (acute AMR, 33.3%; chronic AMR, 41.7%). After 2005, we implemented SAFB routinely and any patient having a positive HLA-DSA was considered to be a desensitization candidate. The 52 patients found to have HLA-DSA underwent kidney transplantation after prior treatment with a single dose of rituximab (RIT) and three or four sessions of double-filtration plasmapheresis (DFPP) in addition to regimens commonly used between 2001 and 2004. After 2005, there was a significant reduction in the occurrence of acute and chronic AMR (acute AMR, 4.7%, P < 0.001; chronic AMR, 4.7%, P < 0.001). The 5-year graft survival rate also improved after implementing SAFB (83.3-98.1%, P = 0.032). The RIT/DFPP-induction protocol may improve graft survival even in patients with low-level DSA.
authors: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors: Toshihito
authors: T
authors: Hirai
authors: Naoki
authors: N
authors: Kohei
authors: Kazuya
authors: K
authors: Omoto
authors: Hideki
authors: H
authors: Ishida
authors: Kazunari
authors: K
authors: Tanabe
mesh_terms: D000017:ABO Blood-Group System; D000208:Acute Disease; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000941:Antigens / Q000737:chemistry; D001706:Biopsy; D002908:Chronic Disease; D005260:Female; D006084:Graft Rejection; D006680:HLA Antigens / Q000737:chemistry* / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012189:Retrospective Studies; D000069283:Rituximab; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D000941:Antigens; D006680:HLA Antigens; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069283:Rituximab