Few studies have studied the impact of non-donor-specific antibodies (NDSA) in kidney transplantation (KT), with most showing no impact of these antibodies. As antibody-mediated graft injury results from the recognition of HLA-epitopes, many of them shared by different HLA antigens, a potential deleterious effect of NDSA is foreseeable. Our aim was to determine the impact of NDSA on KT adverse events and survival.

We studied 724 kidney-only graft recipients, transplanted between 2007-14 with a negative CDC crossmatch. In all patients, solid-phase assays were performed in pre-KT sera for the detection of anti-HLA antibodies. Donor HLA typing was done in order to assign these antibodies as DSA or NDSA. Patients detected to have DSA (n=47) were excluded, hence defining the study cohort (n=677).

Cohort median follow-up time was 4.8 years.

Comparison of variables between NDSA and non-sensitized (NS) patients

Graft survival curves Graft survival curves stratified for induction used Analysis of independent predictors of graft failure using a multivariable (variables included: donor type, retransplant, PRA, HLA mismatch, DGF, induction, NDSA, ABMR) Cox regression

Our study shows that NDSA are associated with an higher risk of ABMR and poorer graft survival. Importantly, NDSA adverse survival impact was restricted to non ATG-induced patients. NDSA should be taken into account when stratifying the immunological risk of a given KT.

CITATION INFORMATION: Malheiro J, Tafulo S, Dias L, Martins L, Beirão I, Castro-Henriques A. Non-Donor-Specific Anti-HLA Antibodies Have an Adverse Impact in Kidney Graft Outcomes. Am J Transplant. 2017;17 (suppl 3).

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