The aim of this research was to determine the clinical impact of pretransplant DSA in the patient and graft survival and renal function after transplantation. To reach these goals, we reviewed all the clinical records of transplanted patients since we introduced the detection of anti-HLA antibodies by flow cytometry with single antigen detection assays (Luminex®), and follow up of at least two years. Their clinical, laboratory and pathological findings were included. Data were analyzed using qui-square, Kaplan-Meier and T tests. P values lower than 0,05 were considered statistically significant. Glomerular filtration rate was estimated by MDRD formula. 240 patients were submitted to kidney transplantation from June, 2009 to November, 2010. Six patients were excluded for insufficient or unavailable anti-HLA antibody data. We found 29 patients with DSA, that were mostly submitted to induction therapy with Anti-thymocyte globulin(n=16) or Basiliximab(n=9) and the standard maintenance therapy was prednisone, sodium mycophenolate and tacrolimus. Two recipients of living donors were submitted to plasma exchange and IVIG due to flow cytometry positive crossmatch. There wasn’t statistically difference between groups related to age and donor source, but DSA group presented significantly more females (58.6% vs 38.4% p=0,038). After two years follow up, DSA group showed a lower graft survival of 69%, compared to 84,8% in the control group (p=0,034), reaching a hazard ratio (HR) of 2,03 for graft loss, an increased risk of acute rejection mediated by antibody (HR of 6,61,p <0,001) and a similar creatinine clearance (42.5+- 18,7 vs 46.2+- 14.9 ml/min, p=0,30). There were no differences in patient survival, delayed graft function or acute cellular rejection and chronic rejection in kidney biopsies. Analyzing the DSA group only, there was an even lower graft survival in patients with more than one DSA (p=0,006). There was no influence on graft survival by class or intensity of higher fluorescence DSA and class of all DSAs present. These data suggest a relevant role of pretransplant DSA in the pathogenesis of graft loss and raise caution in performing the transplant in such patients, especially those with more than one DSA.

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