Purpose : Longitudinal study of C1q complement fraction binding capacity of donor specific anti-HLA antibodies (DSAs) as a pronostic marker in acute antibody-mediated rejection.

Methods : Inclusion of renal transplant recipients from the RITUX ERAH study diagnosed with acute antibody mediated rejection during the first year of transplantation, treated by rituximab or placebo with intravenous immunoglobulins and plasma exchanges. Collection of sera samples at the time of transplantation, the time of rejection, at 3 and 6 months after rejection for centralized analysis with DSAs specificities and C1q binding capacity assessement.

Results: Among the 25 patients included, 17 patients (68%) had C1q binding DSAs at the time of rejection. The presence of C1q binding DSAs was significantly associated with more severe evolution of chronic glomerulopathy at 6 months (p=0.036). The persistence of C1q binding DSAs at 3 months and/or 6 months after rejection was associated with worse chronic glomerulopathy (p=0.006), and more severe C4d score deposition at 6 months after rejection (p=0.008). Proteinuria at 12 months after rejection was worse (p=0.022). C1q binding capacity was associated with the mean fluorescence intensity (MFI) of DSAs at the time of rejection, at 3 and at 6 months after rejection. Nevertheless 2 patients had C1q binding DSAs with low MFI values without prozone effect. After retransplantation, patients had more C1q binding DSAs (p=0.026).

Conclusion: We showed the prognostic value of the presence and the persistence of C1q binding DSAs as a pejorative marker leading to chronic histological lesions and graft dysfunction after antibody-mediated rejection.

CITATION INFORMATION: Bailly E, Proust B, Giral M, Vuiblet V, Chatelet V, Morelon E, Malvezzi P, Caillard S, Barrou B, Couzi L, Sayegh J, Mousson C, Anglicheau D, Grimbert P, Hazzan M, Mourad G, Purgus R, Westeel P, Lebranchu Y, Büchler M. Prognosis Value of the Presence and Persistence of C1q Binding Anti-HLA Antibodies in Acute Antibody-Mediated Rejection in Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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