Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation : A Multicenter Study
Copyright © 2019 by the American Society of Nephrology..
BACKGROUND AND OBJECTIVES: The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively.
RESULTS: Pretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI.
CONCLUSIONS: Preformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.
| Errataetall: |
CommentIn: Clin J Am Soc Nephrol. 2019 Jul 5;14(7):972-974. - PMID 31213509 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 14(2019), 7 vom: 05. Juli, Seite 1056-1066 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ziemann, Malte [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 28.09.2020 Date Revised 01.05.2023 published: Print-Electronic CommentIn: Clin J Am Soc Nephrol. 2019 Jul 5;14(7):972-974. - PMID 31213509 Citation Status MEDLINE |
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| doi: |
10.2215/CJN.13401118 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation |b A Multicenter Study |
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| 500 | |a Date Completed 28.09.2020 | ||
| 500 | |a Date Revised 01.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Clin J Am Soc Nephrol. 2019 Jul 5;14(7):972-974. - PMID 31213509 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation | ||
| 520 | |a DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively | ||
| 520 | |a RESULTS: Pretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI | ||
| 520 | |a CONCLUSIONS: Preformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a Antibodies | |
| 650 | 4 | |a Fluorescence | |
| 650 | 4 | |a HLA-A Antigens | |
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| 650 | 4 | |a Retrospective Studies | |
| 650 | 4 | |a Tissue Donors | |
| 650 | 4 | |a donor-specific HLA antibodies | |
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| 650 | 4 | |a kidney transplantation | |
| 650 | 4 | |a preformed HLA antibodies | |
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