Antibody-Mediated Rejection with and without Donor-Specific Anti-HLA Antibodies: Performance of the Peripheral Blood 8-Gene Expression Assay

E. Van Loon¹, E. Lerut², D. Anglicheau³, W. Gwinner⁴, M. Essig⁵, P. Marquet⁵, M. Naesens¹

¹Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium, ²KU Leuven, Leuven, Belgium, ³Department of Nephrology and Kidney Transplantation, Necker Hospital, Paris, France, ⁴Hannover Medical School, Hannover, Germany, ⁵CHU Limoges, Limoges, France

Meeting: 2020 American Transplant Congress

Abstract number: B-325

Keywords: Antibodies, Gene expression, Non-invasive diagnosis, Rejection

Session Information

Session Name: Poster Session B: Biomarker Discovery and Immune Modulation

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Therapeutic implications of the recently discovered 8-gene expression assay are most clear for detection of antibody-mediated rejection in presence of donor-specific anti-HLA antibodies (HLA-DSA). However, HLA-DSA are not always detectable in cases with histomorphological signs of antibody-mediated rejection (ABMRh), making it a more difficult entity to diagnose.

*Methods: Here, we investigated the diagnostic accuracy of the 8-gene expression assay for ABMRh with or without HLA-DSA in 387 samples.

*Results: In patients with HLA-DSA (N=64), the 8-gene expression assay discriminated DSAposABMRh cases (N=16) with good diagnostic performance (ROC AUC 83.1%, 95% CI 70.8% – 95.3%). In HLA-DSA negative samples (N=323), a fair diagnostic performance was demonstrated for DSAnegABMRh cases (N=30) with a ROC AUC of 75.8% (95% CI 67.4% – 84.4%).Integration with eGFR, proteinuria and age increased the diagnostic performance in HLA-DSA positive samples (ROC AUC 91.9%, 95% CI 82.4% – 100%, p<0.0001) and HLA-DSA negative samples (ROC AUC 79.6%, 95% CI 72.2% - 86.9%, p<0.0001). The 8-gene expression assay associated with graft failure in univariate analysis (HR 1.34, 95% CI 1.03 - 1.75 per unit increase, p=0.03).

*Conclusions: In conclusion, the 8-gene expression assay shows great potential for implementation in clinical practice in the follow-up of high-risk HLA-DSA positive patients, and clinical relevance in HLA-DSA negative cases.

To cite this abstract in AMA style:

Loon EVan, Lerut E, Anglicheau D, Gwinner W, Essig M, Marquet P, Naesens M. Antibody-Mediated Rejection with and without Donor-Specific Anti-HLA Antibodies: Performance of the Peripheral Blood 8-Gene Expression Assay [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/antibody-mediated-rejection-with-and-without-donor-specific-anti-hla-antibodies-performance-of-the-peripheral-blood-8-gene-expression-assay/. Accessed May 11, 2025.

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