title: Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies.
abstract: BACKGROUND
  Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study.
  
  
  METHODS
  Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment.
  
  
  RESULTS
  Patients had a mean number of 1.6 ± 0.8 DSAs with a mean fluorescence intensity value of 2,815 ± 2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129 ± 49 and 159 ± 52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA- groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA- group were similar. Two DSA+ (3%) and five DSA- (2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4 ± 0.6 mg/dL).
  
  
  CONCLUSIONS
  Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSA- patients with pretransplantation immunologic risk assessment.
authors.affiliation: 1 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 2 Department of Pharmacy, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 3 Renal Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 4 Department of Transplant Immunology and Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 5 Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 6 Address correspondence to: Enver Akalin, M.D., Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467.
authors.forename: Kwaku
authors.initials: K
authors.lastname: Marfo
authors.forename: Maria
authors.initials: M
authors.lastname: Ajaimy
authors.forename: Adriana
authors.initials: A
authors.lastname: Colovai
authors.forename: Liise
authors.initials: L
authors.lastname: Kayler
authors.forename: Stuart
authors.initials: S
authors.lastname: Greenstein
authors.forename: Michelle
authors.initials: M
authors.lastname: Lubetzky
authors.forename: Anjali
authors.initials: A
authors.lastname: Gupta
authors.forename: Layla
authors.initials: L
authors.lastname: Kamal
authors.forename: Graciela
authors.initials: G
authors.lastname: de Boccardo
authors.forename: Peter
authors.initials: P
authors.lastname: Masiakos
authors.forename: Milan
authors.initials: M
authors.lastname: Kinkhabwala
authors.forename: Enver
authors.initials: E
authors.lastname: Akalin
mesh_terms: D000328:Adult; D000368:Aged; D000918:Antibody Specificity; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies