Donor-Specific HLA Antibodies in Crossmatch Negative Renal Transplant Patients Associates with Delayed Graft Function
Clinical Laboratory, Finnish Red Cross Blood Service, Helsinki, Finland
Renal Transplant Unit, Helsinki Universtity Hospital, Helsinki, Finland
University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
Meeting: 2013 American Transplant Congress
Abstract number: D1664
In kidney transplantation delayed graft function (DGF) is a significant clinical problem affecting the kidney allograft during the whole clinical course. DGF also leads to higher transplantation costs due to prolonged hospitalization and dialysis costs. Antibody detection with sensitive solid phase methods has revealed that a number of patients have antibodies directed against the graft already before transplantation regardless of negative crossmatch result. It is known that presensitization increases the risk of DGF, but only limited studies has been performed with modern sensitive antibody identification methods. Previous studies have not been able to prove donor specific HLA antibodies (DSA) as a risk for DGF. The purpose of our study was to examine the role of DSA on DGF. We hypothesized that pre-existing DSA even with negative prospective cytotoxic crossmatch poses a significant risk for DGF.
A total of 799 consecutive adult (≥ 16 years) patients who received transplants during 2000-2004 were included in the present study. All patients had negative cytotoxic crossmatch performed with spleen-derived lymphocytes. DGF was designated if at least one of the following criteria was fulfilled: 1. Serum creatinine more than 500 mol/L throughout the first week after transplantation; 2. More than one dialysis sessions during the first perioperative week; 3. Oliguria (<1 l per day) 2 days after transplantation. Screening and identification of HLA-antibodies was performed retrospectively using Luminex-based commercial kits (LABScreen, One Lambda Inc.).
Of the 799 patients 275 (34%) had pre-existing HLA antibodies. DSA were detected in 106 (13%) patients. The overall DGF rate in our study was 28% (227/799). The incidence of DGF for non-immunized patients and non-DSA patients were 25% (133/524) and 27% (46/169), respectively, p = 0.6861. Patients with DSA had significantly higher incidence of DGF (48/106) when compared to patients with non-DSA (45% and 27% respectively, p = 0.0026).
In conclusion, the risk of DGF is nearly twice as high in patients having preformed antibodies against the graft. DSA is a modifiable risk factor that can be obviated with careful organ allocation relying on careful pre transplant analysis of non-accepted mismatches determined with sensitive solid phase methods.
To cite this abstract in AMA style:
Peräsaari J, Kyllönen L, Salmela K, Merenmies J. Donor-Specific HLA Antibodies in Crossmatch Negative Renal Transplant Patients Associates with Delayed Graft Function [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/donor-specific-hla-antibodies-in-crossmatch-negative-renal-transplant-patients-associates-with-delayed-graft-function/. Accessed June 6, 2025.« Back to 2013 American Transplant Congress