Pre-existing donor-specific antibodies are detrimental to kidney allograft only when persistent after transplantation.
Donor-specific antibodies (DSA) increase the risk of allograft rejection and graft failure. They may be present before transplant or develop de novo after transplantation. Here, we studied the evolution of preformed DSA and their impact on graft outcome in kidney transplant recipients. Using the Luminex Single Antigen assay, we analyzed the sera on the day of transplantation of 239 patients who received a kidney transplant. Thirty-seven patients (15.5%) had pre-existing DSA detected the day of transplantation. After 5 years, the pre-existing DSA disappeared in 22 patients whereas they persisted in 12. Variables associated with DSA persistence were age <50 years (P = 0.009), a history of previous transplantation (P = 0.039), the presence of class II DSA (P = 0.009), an MFI of preformed DSA >3500 (P < 0.001), and the presence of two or more DSA (P < 0.001). DSA persistence was associated with a higher risk of graft loss and antibody-mediated rejection. Previously undetected preformed DSA are deleterious to graft survival only when they persist after transplantation.
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Sophie
S
Caillard
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Camille
C
Becmeur
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Gabriela
G
Gautier-Vargas
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.|Department of Nephropathology, University Hospital of Strasbourg, Strasbourg, France.
Jerome
J
Olagne
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Clotilde
C
Muller
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Noelle
N
Cognard
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Peggy
P
Perrin
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Laura
L
Braun
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Francoise
F
Heibel
Public Health Department, University Hospital of Strasbourg, Strasbourg, France.
Francois
F
Lefebre
Histocompatibility Laboratory, UMR_S949 Inserm, Strasbourg, France.
Veronique
V
Renner
Histocompatibility Laboratory, UMR_S949 Inserm, Strasbourg, France.
Christian
C
Gachet
Department of Nephrology, Division of Renal Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Bruno
B
Moulin
Histocompatibility Laboratory, UMR_S949 Inserm, Strasbourg, France.
Anne
A
Parissiadis
D000328:Adult; D064591:Allografts / Q000276:immunology; D019540:Area Under Curve; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D051437:Renal Insufficiency / Q000276:immunology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014019:Tissue Donors
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies
antibody-mediated rejection; donor-specific antibody; graft survival; kidney transplantation