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Impact of C3d and C1q-Binding DSA Detected Long-Term After Kidney Transplantation.

M. Crespo,1,2 D. Redondo,1,2 C. Garcia,3 J. Gimeno,4 M. Perez,1,2 M. Mir,1 J. Hernandez,3 J. Yelamos,2 A. Faura,1,2 J. Pascual.1,2

1Nephrology and Transplant, Hospital del Mar, Barcelona, Spain
2Medical Research Institute (IMIM), Hospital del Mar, Barcelona, Spain
3Catalunya Reference Laboratory, Barcelona, Spain
4Pathology, Hospital del Mar, Barcelona, Spain.

Meeting: 2016 American Transplant Congress

Abstract number: D16

Keywords: HLA antibodies, Kidney transplantation, Rejection, Survival

Session Information

Date: Tuesday, June 14, 2016

Session Name: Poster Session D: Antibody Mediated Rejection: Session #2

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Related Abstracts
  • Clinical Significance of C3d Binding Donor Specific Anti-HLA Antibodies (DSA) Detected by Single Antigen Beads (SAB) After Kidney Transplantation.
  • Clinical Outcome of Patients With De Novo C1q Binding Donor-Specific HLA Antibodies After Renal Transplantation

HLA DSA detected after kidney transplantation(KT) correlate with outcome, but not all are equal and produce the same functional consequences. Early complement-binding DSA were asssociated with ABMR and loss, but information is scarce on late complement-binding DSA. We evaluated C3d and C1q-binding DSA long-term after KT and their impact on graft survival, function and histology.

METHODS: Prospective study of 440 active KT (transplanted 1979-2012) with HLA antibody tests from 2008 to 10/15 or graft-loss. 1-4 samples per patient analyzed with Screening beads, and Single Antigen Beads when needed. DSA were assesed for C3d and C1q-binding capacity. Demographics and clinical data were collected. For analysis, we selected the first time point with C3d+DSA, first DSA when C3d- or first test time in the absence of DSA (median time post-KT 31 months).

RESULTS: KT were55+12 years-old, 37.7%women, 16%re-transplants, creat 1.73mg/dl, MDRD4-FGE 45.6 ml/min and urine protein/creatinine: 331 mg/g at study point.After excluding 11 KT(inadequate sampling or DSA I only), 379 had no DSA and 51 showed DSA II: 34 C3d+ and 17 C3d-DSA. At 63 months median follow-up, C3d+DSA KT showed worse death-censored graft survival than no DSA KT(61.8 vs 89.6%,p=0.000), but C3d-neg DSA did not (82.4%,p=0.13). C3d+DSA had higher proteinuria (498.9+85.5 vs 129.5+33.4, p=0.02). C3d+ and C3d- KT were similar in age, gender, transplant number, pretransplant DSA (when present,100% and 71% C3d+), acute rejection rate, immunosuppression, creatinine and GFR at DSA time.

Most DSA were DQ despite C3d, but C3d+ were stronger than C3d-(MFI:13800+5842 vs 6365+5424,p=0.000). Of 34 patients with biopsies before loss, C3d+DSA KT showed more ABMR than C3d-DSA (83.33 vs 60%,p=0.19) with higher microinflammation(p=0.06) but similar rate of C4d+ or chronic transplant glomerulopathy.

C1q was tested in 43 KT with DSAII: 25 C1q+ and 18 neg. Results were concordant with C3d in 81.4%. Of 8 discordant patients:7 C1q-C3d+: 2 lost grafts, 4 had ABMR on biopsies, only 1 had no ABMR; 1 C1q+C3d- patient had a biopsy without AMR.

CONCLUSIONS: C3d+DSAII late after KT identify recipients at higher risk of graft-loss and ABMR. Based on outcomes, C1q lacked to categorize adequately a significant number of DSAII patients compared with C3d.

CITATION INFORMATION: Crespo M, Redondo D, Garcia C, Gimeno J, Perez M, Mir M, Hernandez J, Yelamos J, Faura A, Pascual J. Impact of C3d and C1q-Binding DSA Detected Long-Term After Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Crespo M, Redondo D, Garcia C, Gimeno J, Perez M, Mir M, Hernandez J, Yelamos J, Faura A, Pascual J. Impact of C3d and C1q-Binding DSA Detected Long-Term After Kidney Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-c3d-and-c1q-binding-dsa-detected-long-term-after-kidney-transplantation/. Accessed February 25, 2021.

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