C3d-Binding Anti-DQ DSA Is Associated with a High Risk for Late ABMR and Graft Failure in Stable Kidney Transplant Recipients.
1Medicine, Maryknoll Medical Center, Busan, Republic of Korea
2Laboratyory Medicine, Maryknoll Medical Center, Busan, Republic of Korea
3Surgery, Maryknoll Medical Center, Busan, Republic of Korea
4Urology, Maryknoll Medical Center, Busan, Republic of Korea
5Pathology, Maryknoll Medical Center, Busan, Republic of Korea
Meeting: 2017 American Transplant Congress
Abstract number: A25
Keywords: HLA antibodies, Kidney transplantation, Panel reactive antibodies, Protocol biopsy
Session Information
Session Name: Poster Session A: Antibody Mediated Rejection in Kidney Transplant Recipients I
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Introduction:Donor specific anti-HLA antibodies (DSA) are a major cause of antibody-mediated rejection (ABMR) and poor graft outcome in kidney transplant recipients (KTR). Critical issue is whether detected antibodies would be clinically relevant. Given complement activation is a contributor to AMBR, evaluating the ability of DSAs to activate the complement cascade is important.Our study was to evaluate to whether C3d-binding DSA can predict ABMR and graft failure in stable KTRs. We compare prevalence of ABMR and graft outcome between SA-DSA with C3d-DSA test, and also analyze the risk factors for graft failure.
Method: We examined 220 stable KTRs for DSAs from July of 2013 to July of 2016. We biopsied 24 recipients who were on positive on Luminex PRA and tested C3d-binding DSAs and SA-DSA assays.
Result:10.9% (24of 220) of stable KTRs had DSAs on Luminex PRA, Median timing of DSA occurring was 9.6(0.2-24) year of posttransplantation.Mean follow up was 18.5(1-50) month. 18 of 24 (75%) had DSAs on SA Luminex assays. 11 of 24 (46%) had C3d-binding DSAs. Most of DSAs belong to class2, anti-DQ antibodies (88.9%, eight of 9). Three patients had graft failure at 2.6 (0.5- 3) year after ABMR. Incidence of ABMR and microvascular inflammation was significantly higher in C3d-DSA (+) than C3d-DSA (-) (7 of 11, 63.3% vs. 1 of 13, 7.7%, P<0.01). ROC curve showed C3d-class2 is more accurate test to detect ABMR than class2-DSA (P<0.001). Significant predictors of graft failure on multivariate analysis were high serum creatinine at the time of biopsy, ABMR, CABMR and Class2, C3d-DSA (+).Class2,C3d-DSA (+) had significantly lower death censored graft survival (DCGS) than Class2, C3d-DSA(-), Class2 SA-DSA (+) tended to have lower DCGS but did not reach significance.
Conclusion:We demonstrated that C3d-binding anti-DQ DSA was significantly associated with a high risk for ABMR and graft failure in stable KTRs. However, our study was too small and short, so we need to verify with larger and longer-term study. We suggest immune surveillance with C3d-DSA and subsequent allograft biopsy may be useful method to recognize ABMR early and to prevent graft failure in stable KTRs.
CITATION INFORMATION: Lee D, Kim B, Kim J, Kim I, Chun M. C3d-Binding Anti-DQ DSA Is Associated with a High Risk for Late ABMR and Graft Failure in Stable Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Lee D, Kim B, Kim J, Kim I, Chun M. C3d-Binding Anti-DQ DSA Is Associated with a High Risk for Late ABMR and Graft Failure in Stable Kidney Transplant Recipients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/c3d-binding-anti-dq-dsa-is-associated-with-a-high-risk-for-late-abmr-and-graft-failure-in-stable-kidney-transplant-recipients/. Accessed May 25, 2025.« Back to 2017 American Transplant Congress