title: De novo donor-specific anti-HLA antibodies after kidney transplantation are associated with impaired graft outcome independently of their C1q-binding ability.
abstract: Many aspects of post-transplant monitoring of donor-specific (DSA) and non-donor-specific (nDSA) anti-HLA antibodies on renal allograft survival are still unclear. Differentiating them by their ability to bind C1q may offer a better risk assessment. We retrospectively investigated the clinical relevance of de novo C1q-binding anti-HLA antibodies on graft outcome in 611 renal transplant recipients. Acute rejection (AR), renal function, and graft survival were assessed within a mean follow-up of 6.66 years. Post-transplant 6.5% patients developed de novo DSA and 11.5% de novo nDSA. DSA (60.0%; P < 0.0001) but not nDSA (34.1%, P = 0.4788) increased rate of AR as compared with controls (27.4%). C1q-binding anti-HLA antibodies did not alter rate of AR in both groups. Renal function was only significantly diminished in patients with DSAC1q+. However, DSA significantly impaired 5-year graft survival (65.2%; P < 0.0001) in comparison with nDSA (86.7%; P = 0.0054) and controls (90.7%). While graft survival did not differ between DSAC1q-and DSAC1q+recipients, 5-year allograft survival was reduced in nDSAC1q+(80.9%) versus nDSAC1q-(90.7%, P = 0.0251). De novo DSA independently of their ability to bind C1q are associated with diminished graft survival.
authors.affiliation: Laboratory of Immunogenetics, University Hospital Munich, Munich, Germany.|Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Kauke
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology - IBE, Chair for Public Health and Health Services Research, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Oberhauser
authors.affiliation: Laboratory of Immunogenetics, University Hospital Munich, Munich, Germany.|Transplant Center, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Viviane
authors.initials: V
authors.lastname: Lin
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology - IBE, Chair for Public Health and Health Services Research, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Coenen
authors.affiliation: Renal Division, Department of Internal Medicine IV, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Fischereder
authors.affiliation: Laboratory of Immunogenetics, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dick
authors.affiliation: Renal Division, Department of Internal Medicine IV, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Schoenermarck
authors.affiliation: Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
authors.affiliation: Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Andrassy
authors.affiliation: Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Transplant Center, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.affiliation: Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Angele
authors.affiliation: Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Stangl
authors.affiliation: Transplant Center, University Hospital Munich, Munich, Germany.|Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Habicht
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D001706:Biopsy; D015922:Complement C1q / Q000276:immunology*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D015922:Complement C1q
keywords: 
  donor-specific anti-HLA antibodies
  ; C1q; anti-HLA antibodies; kidney transplantation