Dynamics of Donor-Specific Antibodies in Kidney Transplantation: Pretransplant Anti-HLA Class I DSA Not Associated to Early Graft Loss Disappear after Transplantation under Conventional Immunosuppression
Nephrology, Hospital del Mar, Barcelona, Spain
Immunology, Hospital Insular, Las Palmas, Spain
Immunology, LRC, Hospital del Mar, Barcelona, Spain
Immunology, Hospital del Mar, Barcelona, Spain
Meeting: 2013 American Transplant Congress
Abstract number: A639
The impact of donor-specific antibodies(DSA) after kidney transplantation(KT) on graft survival is becoming clearer, but which DSA have the greater impact or how they behave after KT is still imprecise.
Methods: We focused on KT recipients with grafts functioning more than 3 months. 440 KT performed 1979-2012 with a negative CDC crossmatch were included in a prospective study between I/2008-III/2012.Anti-HLA antibodies were tested using Luminex Lifecodes LifeScreen and LSA Class I and/or Class II assays. Cut-off for a positive reaction was set in MFI raw value>1000.
Results: At 4 years follow-up, 33 patients lost their grafts, 21 died and 5 were lost to follow-up. We found:
– PreKT DSA in 43/289(14.9%) patients: 5 HLA-I, 36 HLA-II, 7 HLA-I&II. Graft survival was not significantly different to preKT DSA-negative patients. AllpreKT DSA-I and 50% DSA-II disappeared postKT.
– First postKT tests showed DSA in 26/247(6.7%), median 54 months post-KT: 3 HLA-I and 23 HLA-II (immunodominance:16 DQB1,3 DRB1,1DRB3,1DRB4,2 DRB5). Graft survival was lower in DSA-positive patients (p<0.0001 uncensored, p=0.002 censored, median follow-up 32 months). Graft loss occurred in 58% DSA-positive KT performed>5 years before, 37.5% transplanted 1-5 years before and 0% DSA+ patients<1 year after KT. Interestingly, 50% DQ DSA>7000MFI lost their grafts.
– Second monitoring showed DSA in 41/288(10.6%), median 59 months post-KT and 32 after first post-KT tests:3 HLA I, 35 HLA-II, 3 I&II. Immunodominant DSA were again 58% DQ. At least 18 were de novo DSA, 19 preformed, 5 unknown. There were not significant differences between de novo and preformed DSA except for less retransplants, lower PRA and longer postTR follow-up(103.8+78 vs 38+29 months, p=0.003), but similar DSA specificity and MFI level (11792+7153 vs 8964+ 6921).
Conclusion: PreKT DSA-I not associated to early graft loss disappeared after KTR under conventional immunosuppression, as well as 50% of DSA-II. Postransplant DSA significantly impact graft survival, especially high MFI DQ DSA or DSA in long-term transplant patients. Around half postransplant DSA are de novo but are similar to preformed DSA in MFI or specificity.
To cite this abstract in AMA style:
Crespo M, Torio A, Mas V, Perez-Saez M, Mir M, Faura A, Yelamos J, López-Botet M, Pascual J. Dynamics of Donor-Specific Antibodies in Kidney Transplantation: Pretransplant Anti-HLA Class I DSA Not Associated to Early Graft Loss Disappear after Transplantation under Conventional Immunosuppression [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/dynamics-of-donor-specific-antibodies-in-kidney-transplantation-pretransplant-anti-hla-class-i-dsa-not-associated-to-early-graft-loss-disappear-after-transplantation-under-conventional-immunosuppress/. Accessed May 17, 2025.« Back to 2013 American Transplant Congress