title: Value of Donor-Specific Anti-HLA Antibody Monitoring and Characterization for Risk Stratification of Kidney Allograft Loss.
abstract: The diagnosis system for allograft loss lacks accurate individual risk stratification on the basis of donor-specific anti-HLA antibody (anti-HLA DSA) characterization. We investigated whether systematic monitoring of DSA with extensive characterization increases performance in predicting kidney allograft loss. This prospective study included 851 kidney recipients transplanted between 2008 and 2010 who were systematically screened for DSA at transplant, 1 and 2 years post-transplant, and the time of post-transplant clinical events. We assessed DSA characteristics and performed systematic allograft biopsies at the time of post-transplant serum evaluation. At transplant, 110 (12.9%) patients had DSAs; post-transplant screening identified 186 (21.9%) DSA-positive patients. Post-transplant DSA monitoring improved the prediction of allograft loss when added to a model that included traditional determinants of allograft loss (increase in c statistic from 0.67; 95% confidence interval [95% CI], 0.62 to 0.73 to 0.72; 95% CI, 0.67 to 0.77). Addition of DSA IgG3 positivity or C1q binding capacity increased discrimination performance of the traditional model at transplant and post-transplant. Compared with DSA mean fluorescence intensity, DSA IgG3 positivity and C1q binding capacity adequately reclassified patients at lower or higher risk for allograft loss at transplant (category-free net reclassification index, 1.30; 95% CI, 0.94 to 1.67; P<0.001 and 0.93; 95% CI, 0.49 to 1.36; P<0.001, respectively) and post-transplant (category-free net reclassification index, 1.33; 95% CI, 1.03 to 1.62; P<0.001 and 0.95; 95% CI, 0.62 to 1.28; P<0.001, respectively). Thus, pre- and post-transplant DSA monitoring and characterization may improve individual risk stratification for kidney allograft loss.
authors: Departments of Nephrology and Kidney Transplantation and.|Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France.
authors: Denis
authors: D
authors: Viglietti
authors: Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France.|Departments of Kidney Transplantation and.
authors: Alexandre
authors: A
authors: Loupy
authors: Methodology Unit (EA 3181) CHRU de Besançon, France; and.
authors: Dewi
authors: D
authors: Vernerey
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Carol
authors: C
authors: Bentlejewski
authors: Pathology, Saint Louis Hospital and.
authors: Clément
authors: C
authors: Gosset
authors: Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France.
authors: Olivier
authors: O
authors: Aubert
authors: Pathology, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
authors: Jean-Paul
authors: JP
authors: Duong van Huyen
authors: Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France.
authors: Xavier
authors: X
authors: Jouven
authors: Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France.|Departments of Kidney Transplantation and.
authors: Christophe
authors: C
authors: Legendre
authors: Departments of Nephrology and Kidney Transplantation and.|Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France.
authors: Denis
authors: D
authors: Glotz
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Adriana
authors: A
authors: Zeevi
authors: Departments of Nephrology and Kidney Transplantation and carmen.lefaucheur@wanadoo.fr.|Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France.
authors: Carmen
authors: C
authors: Lefaucheur
mesh_terms: D000906:Antibodies / Q000097:blood*; D005260:Female; D006084:Graft Rejection / Q000097:blood* / Q000453:epidemiology* / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D014019:Tissue Donors
chemical_list: D000906:Antibodies; D006680:HLA Antigens
keywords: immunology; kidney transplantation; transplant outcomes