title: Donor-specific antibodies adversely affect kidney allograft outcomes.
abstract: The effect of low titers of donor-specific antibodies (DSAs) detected only by sensitive solid-phase assays (SPAs) on renal transplant outcomes is unclear. We report the results of a systematic review and meta-analysis of rejection rates and graft outcomes for renal transplant recipients with such preformed DSAs, defined by positive results on SPA but negative complement-dependent cytotoxicity and flow cytometry crossmatch results. Our search identified seven retrospective cohort studies comprising a total of 1119 patients, including 145 with isolated DSA-SPA. Together, these studies suggest that the presence of DSA-SPA, despite a negative flow cytometry crossmatch result, nearly doubles the risk for antibody-mediated rejection (relative risk [RR], 1.98; 95% confidence interval [CI], 1.36-2.89; P<0.001) and increases the risk for graft failure by 76% (RR, 1.76; 95% CI, 1.13-2.74; P=0.01). These results suggest that donor selection should consider the presence of antibodies in the recipient, identified by the SPA, even in the presence of a negative flow cytometry crossmatch result.
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA. sm2206@columbia.edu
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.forename: Amudha
authors.initials: A
authors.lastname: Palanisamy
authors.forename: Demetra
authors.initials: D
authors.lastname: Tsapepas
authors.forename: Bekir
authors.initials: B
authors.lastname: Tanriover
authors.forename: R John
authors.initials: RJ
authors.lastname: Crew
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dube
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Ratner
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Jai
authors.initials: J
authors.lastname: Radhakrishnan
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D014181:Transplantation Immunology; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome