title: Risk of antibody-mediated rejection in kidney transplant recipients with anti-HLA-C donor-specific antibodies.
abstract: Anti-HLA donor-specific antibodies (DSAs) cause acute and chronic antibody-mediated rejection (AMR). However, the clinical relevance of anti-HLA-C antibodies remains unclear. We evaluated the clinical relevance of the presence of anti-HLA-C DSA at day 0 in renal transplant recipients. In this retrospective, case-controlled study, 608 patients who underwent kidney transplantation between August 2008 and March 2012 were screened for the presence of isolated anti-HLA-C DSA at day 0. A total of 22 renal transplant recipients were selected and followed for a period of 1 year. AMR was classified according to the Banff classification. The 22 patients were compared with 88 immunized patients. Acute AMR was diagnosed in six patients (27.3%). The median level of DSA at day 0 was 1179 (530-17,941). The mean fluorescence intensity in the anti-C group was 4966 (978-17,941) in the AMR group and 981 (530-8012) in the group of patients without AMR. Acute AMR was diagnosed less frequently in the 88 immunized individuals (9.1%) than in the DSA anti-C group (p = 0.033). The level of DSA at day 0 was predictive for AMR (p = 0.017). Patients with a high level of pretransplant anti-HLA-C DSAs are likely to develop acute AMR during the first year after transplantation.
authors.affiliation: Service de Néphrologie-Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Aubert
authors.forename: M-C
authors.initials: MC
authors.lastname: Bories
authors.forename: C
authors.initials: C
authors.lastname: Suberbielle
authors.forename: R
authors.initials: R
authors.lastname: Snanoudj
authors.forename: D
authors.initials: D
authors.lastname: Anglicheau
authors.forename: M
authors.initials: M
authors.lastname: Rabant
authors.forename: F
authors.initials: F
authors.lastname: Martinez
authors.forename: A
authors.initials: A
authors.lastname: Scemla
authors.forename: C
authors.initials: C
authors.lastname: Legendre
authors.forename: R
authors.initials: R
authors.lastname: Sberro-Soussan
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D015236:HLA-C Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D015236:HLA-C Antigens
keywords: Antibody-mediated rejection; anti-HLA-C; donor-specific antibody; renal transplantation