title: Donor-Specific Antibody Monitoring: Where Is the Beef?
abstract: This review paper discusses the impact of de novo donor-specific antibodies (DSA) to donor HLA antigens in kidney transplantation and summarizes the benefits and challenges that exist with DSA monitoring. Post-transplant DSA is associated with worse allograft outcomes and its detection may precede or coincide with clinical, biochemical, and histologic allograft dysfunction. There are no absolute features of DSA testing results that perfectly discriminate between states of disease and health. In a state of antibody-associated graft dysfunction, removal or reduction in DSA may only provide clinical benefit for some. Furthermore, various factors influence test results, and detection of HLA antibodies must be interpreted within the appropriate clinical and laboratory context. The utility of DSA monitoring is further affected by the limited effectiveness of treatment for antibody-mediated rejection. Although DSA monitoring is potentially beneficial in some circumstances, the optimal screening and treatment strategies are still to be defined.
authors.affiliation: Division of Nephrology, Department of Medicine, Multiorgan Transplant Program, and Regional HLA Laboratory, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada; Kidney and Pancreas Transplantation, Henry Ford Transplant Institute, Wayne State University, Detroit, MI.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ma
authors.affiliation: Division of Nephrology, Department of Medicine, Multiorgan Transplant Program, and Regional HLA Laboratory, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada; Kidney and Pancreas Transplantation, Henry Ford Transplant Institute, Wayne State University, Detroit, MI.
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Nephrology, Department of Medicine, Multiorgan Transplant Program, and Regional HLA Laboratory, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada; Kidney and Pancreas Transplantation, Henry Ford Transplant Institute, Wayne State University, Detroit, MI. Electronic address: kathryn.tinckam@uhn.ca.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Tinckam
mesh_terms: D001323:Autoantibodies / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation; D014019:Tissue Donors
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens
keywords: Antibody-mediated outcomes; Donor-specific HLA antibodies; Kidney transplantation; Post-transplant human leukocyte antigen (HLA) antibody; Surveillance antibody monitoring