Pretransplant human leukocyte antigen antibodies detected by single-antigen bead assay are a risk factor for long-term kidney graft loss even in the absence of donor-specific antibodies.
Clinical relevance of ELISA- and single-antigen bead assay (SAB)-detected pretransplant HLA antibodies (SAB-HLA-Ab) for kidney graft survival was evaluated retrospectively in 197 patients transplanted between 2002 and 2009 at the University Clinic Frankfurt. Having adjusted for retransplantation and delayed graft function, a significantly increased risk for death-censored graft loss was found in patients with pretransplant SAB-HLA-Ab [HR: 4.46; 95% confidence interval (CI): 1.47-13.48; P = 0.008]. The risk for increased graft loss was also significant in patients with pretransplant SAB-HLA-Ab but without SAB-detected donor-specific Ab (SAB-DSA) (HR: 4.91; 95% CI of 1.43-16.991; P = 0.012). ELISA was not sufficient to identify pretransplant immunized patients with an increased risk for graft loss. In immunized patients, graft loss was predominantly present in patients who received transplants with a mismatch on the HLA-DR locus. In conclusion, even if our study is limited due to small sample size, the results show an increased risk for long-term graft loss in patients with pretransplant SAB-HLA, even in the absence of DSA. SAB-HLA-Ab-positive patients, being negative in ELISA or CDC assay, might profit from a well-HLA-DR-matched graft and intensified immunosuppression.
Department of Transplantation Immunology, Institute of Transfusion Medicine, German Red Cross, Blood Donation Service Baden-Württemberg-Hessen, Frankfurt, Germany.
Rudolf
R
Richter
Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
Caner
C
Süsal
Department of Transplantation Immunology, Institute of Transfusion Medicine, German Red Cross, Blood Donation Service Baden-Württemberg-Hessen, Frankfurt, Germany.|Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Stefanie
S
Köhler
Department of Transplantation Immunology, Institute of Transfusion Medicine, German Red Cross, Blood Donation Service Baden-Württemberg-Hessen, Frankfurt, Germany.|Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Sara
S
Qidan
Department of Transplantation Immunology, Institute of Transfusion Medicine, German Red Cross, Blood Donation Service Baden-Württemberg-Hessen, Frankfurt, Germany.|Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Alicia
A
Schödel
Department of Transplantation Immunology, Institute of Transfusion Medicine, German Red Cross, Blood Donation Service Baden-Württemberg-Hessen, Frankfurt, Germany.|Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Lisa
L
Holschuh
Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Martin
M
Brzoska
Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Aida
A
Asbe-Vollkopf
Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Stefan
S
Büttner
Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Christoph
C
Betz
Institute for Biostatistics and Mathematical Modelling, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Eva
E
Herrmann
Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Stefan
S
Gauer
Department of Transplantation Immunology, Institute of Transfusion Medicine, German Red Cross, Blood Donation Service Baden-Württemberg-Hessen, Frankfurt, Germany.
Erhard
E
Seifried
Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Helmut
H
Geiger
Department of Transplantation Immunology, Institute of Transfusion Medicine, German Red Cross, Blood Donation Service Baden-Württemberg-Hessen, Frankfurt, Germany.
Christian
C
Seidl
Department of Nephrology, University Clinic Frankfurt, Goethe-University, Frankfurt, Germany.
Ingeborg A
IA
Hauser
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood*; D001706:Biopsy; D051799:Delayed Graft Function / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007114:Immunization; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000097:blood; D051437:Renal Insufficiency / Q000276:immunology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors
D000906:Antibodies; D006680:HLA Antigens; D007166:Immunosuppressive Agents
HLA class-I antibody; HLA class-II antibody; HLA-DR; renal transplantation; single-antigen bead assay