Impact of Preformed Anti-HLA Antibodies in the Outcomes of Kidney Transplantation.
1Nephrology, Hospital Santo António, CHP, Porto, Portugal
2Nephrology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
Meeting: 2016 American Transplant Congress
Abstract number: A265
Keywords: HLA antibodies, Outcome, Rejection
Session Information
Session Name: Poster Session A: Poster Session III: Kidney Complications-Other
Session Type: Poster Session
Date: Saturday, June 11, 2016
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Background:Anti-HLA antibodies are risk factors for acute and chronic rejection and allograft loss. Its detection represents a major advance and is widely used in organ allocation and pretransplant risk assessment. Our aim was to understand the impact of preformed anti-HLA antibodies on clinical outcomes. Methods:We enrolled 102 aleatory patients who received a kidney transplant (KT) from 2010 to 2015, at our Center. Donor–recipient pairs were typed for HLA-A, B, DR, and DQ before transplantation. All patients were transplanted with a negative cytotoxic crossmatch. We divided the patients in three groups: a) group with no anti-HLA antibodies (n=54), b) group with non-donor-specific antibody (NDSA) (n=28) and c) group with donor-specific antibody (DSA) (n=20). Results:Table 1 compares the characteristics of the three groups.
| No anti-HLA antibodies,N=54 | NDSA,N=28 | DSA,N=20 | P | |
| Age,y | 45.6±16.4 | 47.3±12.0 | 46.0±10.1 | 0.85 |
| Female sex | 23(42.6) | 20(71.4) | 10(50.0) | 0.04 |
| Previous KT | 10(18.5) | 10(35.7) | 9(45.0) | 0.02 |
| Pregnancy | 11(20.4) | 17(60.7) | 7(35.0) | 0.04 |
| Blood transfusion | 17(31.5) | 16(57.1) | 8(40.0) | 0.23 |
| HLA total mismatches | 3.22±1.50 | 3.29±1.30 | 3.30±1.38 | 0.97 |
| Median calculated PRA cytotoxic (range) | 0 | 78.9(10.1-100) | 82.8(4.1-100) | <0.001 |
|
Acute rejection |
4(7.5) |
3(11.1) |
7(35.0) |
0.01 |
| AMR | 0 | 1 | 6 | |
| CMR | 4 | 2 | 1 | |
| Follow-up,y | 3.7±1.6 | 3.3±1.9 | 3.4±1.7 | 0.63 |
Acute rejection incidence was higher in DSA group (35% vs. 11% in NDSA group and vs. 7.5% in group with no anti-HLA antibodies, P=0.01). This was primarily due to antibody-mediated rejection (AMR). Graf function assessment using MDRD calculation at month 3, month 6 and then annually indicated that at the 4th year the DSA group had significantly lower glomerular filtration rate (median in DSA group was 43.2mL/min, in NDSA group was 46.3mL/min and in group with no anti-HLA antibodies was 55.7mL/min, P<0.05). At the end of the follow-up only 7 patients lost their grafts and death occurred in 9 patients: no statistically significant difference between groups. Conclusions:Patients transplanted with DSA presented a higher incidence of AMR and lower graft function at 4-years. Nevertheless, no clear effect of preformed anti-HLA antibodies (DSA or non-DSA) on mid-term kidney graft survival was observed.
CITATION INFORMATION: Santos S, Malheiro J, Costa M, Campos A, Pedroso S, Almeida M, Martins L, Dias L, Henriques C, Cabrita A. Impact of Preformed Anti-HLA Antibodies in the Outcomes of Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Santos S, Malheiro J, Costa M, Campos A, Pedroso S, Almeida M, Martins L, Dias L, Henriques C, Cabrita A. Impact of Preformed Anti-HLA Antibodies in the Outcomes of Kidney Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-preformed-anti-hla-antibodies-in-the-outcomes-of-kidney-transplantation/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress