The evolution of histological changes suggestive of antibody-mediated injury, in the presence and absence of donor-specific anti-HLA antibodies
© 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd..
The interplay between donor-specific anti-HLA antibodies (HLA-DSA), histology of active antibody-mediated rejection (aABMRh ), transplant glomerulopathy (cg), and graft failure in kidney transplantation remains insufficiently understood. We performed a single-center cohort study (n = 1000) including 2761 protocol and 833 indication biopsies. Patients with pretransplant HLA-DSA were more prone to develop aABMRh (OR 22.7, 95% CI, 11.8-43.7, P < 0.001), cg (OR 5.76, 95% CI, 1.67-19.8, P = 0.006), and aABMRh/cg (OR 19.5, 95% CI, 10.6-35.9, P < 0.001). The negative impact of pre-transplant HLA-DSA on graft survival (HR 2.12, 95% CI, 1.41-3.20, P < 0.001) was partially mediated through aABMRh and cg occurrence. When adjusted for time-dependent HLA-DSA (HR 4.03, 95% CI, 2.21-7.15, P = 0.002), graft failure was only affected by aABMRh when cg was evident. In HLA-DSA negative patients, aABMRh was associated with impaired graft outcome only when evolving to cg (HR 1.32, 95% CI, 1.07-1.61, P = 0.008). We conclude that the kinetics of HLA-DSA are important to estimate the rate of graft failure, and that histological follow-up is necessary to discover, often subclinical, ABMR and cg. In the absence of HLA-DSA, patients experience similar histological lesions and the evolution to transplant glomerulopathy associates with impaired graft outcome.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:34 |
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| Enthalten in: |
Transplant international : official journal of the European Society for Organ Transplantation - 34(2021), 10 vom: 01. Okt., Seite 1824-1836 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Coemans, Maarten [VerfasserIn] |
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| Links: |
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| Themen: |
AABMRh |
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| Anmerkungen: |
Date Completed 18.10.2021 Date Revised 18.10.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/tri.13964 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM327443855 |
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| 520 | |a © 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd. | ||
| 520 | |a The interplay between donor-specific anti-HLA antibodies (HLA-DSA), histology of active antibody-mediated rejection (aABMRh ), transplant glomerulopathy (cg), and graft failure in kidney transplantation remains insufficiently understood. We performed a single-center cohort study (n = 1000) including 2761 protocol and 833 indication biopsies. Patients with pretransplant HLA-DSA were more prone to develop aABMRh (OR 22.7, 95% CI, 11.8-43.7, P < 0.001), cg (OR 5.76, 95% CI, 1.67-19.8, P = 0.006), and aABMRh/cg (OR 19.5, 95% CI, 10.6-35.9, P < 0.001). The negative impact of pre-transplant HLA-DSA on graft survival (HR 2.12, 95% CI, 1.41-3.20, P < 0.001) was partially mediated through aABMRh and cg occurrence. When adjusted for time-dependent HLA-DSA (HR 4.03, 95% CI, 2.21-7.15, P = 0.002), graft failure was only affected by aABMRh when cg was evident. In HLA-DSA negative patients, aABMRh was associated with impaired graft outcome only when evolving to cg (HR 1.32, 95% CI, 1.07-1.61, P = 0.008). We conclude that the kinetics of HLA-DSA are important to estimate the rate of graft failure, and that histological follow-up is necessary to discover, often subclinical, ABMR and cg. In the absence of HLA-DSA, patients experience similar histological lesions and the evolution to transplant glomerulopathy associates with impaired graft outcome | ||
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| 700 | 1 | |a Kuypers, Dirk |e verfasserin |4 aut | |
| 700 | 1 | |a Emonds, Marie-Paule |e verfasserin |4 aut | |
| 700 | 1 | |a Verbeke, Geert |e verfasserin |4 aut | |
| 700 | 1 | |a Naesens, Maarten |e verfasserin |4 aut | |
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