title: Pre-transplant low level HLA antibody shows a composite poor outcome in long-term outcome of renal transplant recipients.
abstract: To determine the significance of low-level DSA (donor specific antibody) in patients transplanted with negative cytotoxicity AHG (antihuman immunoglobulin) crossmatch, data from 279 patients who received a kidney transplant between July 1999 and March 2006 were collected. All kidney recipients received ABO-compatible donors. A poor outcome was defined as any one of the following: death, Cr>2.0 mmol/L, occurrence of a rejection episode. Luminex Screening and Single Antigen assays from Tepnel Life Codes were used to detect human leukocyte antigen antibodies on pre-transplant sera retrospectively. Twenty-four out of 279 recipients demonstrated the presence of solid-phase DSA (MFI>1000) present pre-transplant. In DSA+ group, the accumulated good versus poor outcome rate was 0.30 versus 0.70, respectively. These rates were 0.49 and 0.51, respectively, in the DSA- group. The difference in composite poor outcome between DSA+ versus DSA- group was significant (p=0.030). The DSA- group had no difference in patient survival as compared to the DSA+ group (p=0.061). There is no statistically significant difference for either mortality or outcome results between high MFI (>2000) and low MFI (≤2000) groups. Our data suggest that solid-phase antibodies which are not strong enough to elicit a positive T-AHG crossmatch may influence long-term graft outcome.
authors.affiliation: Department of Transplantation Surgery, Qilu Hospital, Shandong University , Jinan, Shandong , China .
authors.forename: Jun
authors.initials: J
authors.lastname: Tian
authors.forename: Dadong
authors.initials: D
authors.lastname: Li
authors.forename: Tod V
authors.initials: TV
authors.lastname: Alberghini
authors.forename: Michael
authors.initials: M
authors.lastname: Rewinski
authors.forename: Ning
authors.initials: N
authors.lastname: Guo
authors.forename: Laurine M
authors.initials: LM
authors.lastname: Bow
mesh_terms: D000328:Adult; D051799:Delayed Graft Function / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D006680:HLA Antigens
keywords: Donor-specific antibody; HLA antibodies; graft survival; kidney transplantation; luminex; outcome