Donor-specific antibodies present at the time of kidney transplantation in immunologically unmodified patients increase the risk of acute rejection

Abstract Background Human leukocyte antigens (HLA) class II donor-specific antibodies (DSAs) are associated with microcirculation inflammation, transplant glomerulopathy and ultimately graft loss. There is however no data on allograft outcomes in deceased donor kidney transplant recipients who have...

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Bibliographic Details
Published in:Transplant immunology 2016-07, Vol.37, p.18-22
Main Authors: Gupta, Aditi, Murillo, Daniel, Yarlagadda, Sri G, Wang, Connie J, Nawabi, Atta, Schmitt, Timothy, Brimacombe, Michael, Bryan, Christopher F
Format: Article
Language:English
Subjects:
Acute Disease
Acute rejection
Adult
Aged
Allergy and Immunology
Antibody-Dependent Cell Cytotoxicity
Class II DSA
Female
Graft Rejection - epidemiology
Graft survival
Histocompatibility Testing
HLA-DQ Antigens - genetics
HLA-DQ Antigens - immunology
HLA-DR Antigens - genetics
HLA-DR Antigens - immunology
Humans
Immunity, Cellular
Immunization
Isoantibodies - blood
Kidney Transplantation
Male
MFI
Middle Aged
Risk
Tissue Donors
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Summary:Abstract Background Human leukocyte antigens (HLA) class II donor-specific antibodies (DSAs) are associated with microcirculation inflammation, transplant glomerulopathy and ultimately graft loss. There is however no data on allograft outcomes in deceased donor kidney transplant recipients who have not received any desensitization prior to transplantation. Methods We prospectively evaluated the association of HLA DR and DQ DSAs on rejection and short-term graft survival in patients who did not receive desensitization prior to transplantation. On the basis of their cumulative strength of HLA DR and/or DQ DSA, the patients were dichotomized into: 1) median fluorescence intensity (MFI) < 1 000 and 2) MFI ≥ 1 000. Results In the two year study period, 50 consecutive patients with HLA DR and/or DQ sensitization were transplanted in our two centers. Post-transplantation, the incidence of acute rejection was significantly greater in the MFI ≥ 1000 group (35%; 8/22) compared to the MFI < 1000 group (7%; 2/28) ( p < 0.001). There were two graft losses, both in the MFI ≥ 1000 group. Conclusion The strength of DR and/or DQ DSA at the time of renal transplantation influences the risk of rejection in non-desensitized recipients with HLA class II DSA.
ISSN:0966-3274
1878-5492
DOI:10.1016/j.trim.2016.04.007