Analysis of predictive and preventive factors for de novo DSA in kidney transplant recipients.
BACKGROUND
Development of de novo donor-specific anti-HLA antibodies (dnDSA) has been associated with poor graft outcome, although the preventive factor for its production is still elusive. We analyzed the incidence of dnDSA within 5 years posttransplant in 562 living-kidney transplant recipients to evaluate predicting and preventive factors for dnDSA development.


METHODS
All patients were considered to be non-HLA sensitized, as determined by the preoperative single-antigen bead assay (SABA), although they included various ABO blood type compatibilities. Preoperative administration of rituximab was indicated for 48% of patients, mainly for ABO incompatible transplantation. We retrospectively compared the patients with dnDSA and those without.


RESULTS
Development of dnDSA was observed in 27 of the total 562 patients (5%). Chronic rejection was more frequently observed in patients with dnDSA than in those without (41% vs. 6%, P<0.001). The dnDSA-positive patients showed decreased graft function and poorer graft survival rates than those who tested negative. In multivariate analysis, higher likelihood of dnDSA production was observed in male recipients (odds ratio 6.57, P=0.012) and patients with a higher number of HLA-DR mismatches (odds ratio 2.41, P=0.008), whereas lower likelihood was observed in patients treated with rituximab induction (odds ratio 0.33, P=0.040).


CONCLUSIONS
Results suggest that rituximab induction as a standard immunosuppression protocol may have a preventive effect for dnDSA production in the non-HLA sensitized low immunologic risk patients.
1 Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. 2 Address correspondence to: Prof. Kazunari Tanabe, M.D., Ph.D., Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
Toshihito
T
Hirai
Miyuki
M
Furusawa
Kazuya
K
Omoto
Hideki
H
Ishida
Kazunari
K
Tanabe
D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors
D006680:HLA Antigens; D007518:Isoantibodies