Intermediate steroid withdrawal after renal transplantation and anti-HLA antibodies (HLA-Abs) development

Elena Monfá; David San Segundo; Juan Carlos Ruiz San Millán; Judith Sanabria; Zoila Albines; Emilio Rodrigo; Iñigo Romón; Esther Asensio; Manuel Arias; Marcos López-Hoyos

doi:10.1016/j.nefro.2017.02.002

Intermediate steroid withdrawal after renal transplantation and anti-HLA antibodies (HLA-Abs) development

Nefrologia. 2017 Jul-Aug;37(4):415-422. doi: 10.1016/j.nefro.2017.02.002. Epub 2017 Mar 19.

[Article in English, Spanish]

Affiliations

¹ Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain. Electronic address: elenamonfa@gmail.com.
² Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
³ Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
⁴ Pharmacology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
⁵ Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain.

PMID: 28330741
DOI: 10.1016/j.nefro.2017.02.002

Abstract

Introduction: Steroid withdrawal in renal transplantation is desirable to avoid their adverse effects. However, by decreasing the immunosuppression, could lead to an increased risk for the development of HLA-Abs.

Objective: Evaluate the relationship between steroid withdrawal and development of HLA-Abs in renal transplantation.

Methods: We analyzed sera by Luminex from 182 kidney transplants performed from 1998 to 2011, before and two years after transplantation. All the patients had a pretransplant PRA (panel reactive of antibodies) <20% by complement-dependent cytotoxicity (CDC) and maintenance immunosuppression with tacrolimus and mycophenolate mofetil (MMF). We compared a group of steroid withdrawal at 7 months (group-I; n=130) and another control with non-withdrawal (group-II; n=52).

Results: 22 patients (16.9%) in group-I and 11 patients in group-II (21.1%) had HLA-Abs after two years (pNS). Despite excluding patients with PRA >20%, we detected HLA-Abs pretransplant by Luminex in 11.5% of patients in both groups, of which, 66.6%, versus 53% (p 0.058), developed new specificities, with a similar percentage of donor specific antibodies (DSA) in both groups (33.33% vs 36.36%), pNS. In the subgroup without pretransplant HLA-Abs (group-I; n=115, group-II; n=45), 6.08% developed de novo HLA-Abs, being DSA 3.4% (Group-I) versus 7.69% in group II with 3.84% DSA (pNS).

Conclusions: Steroid withdrawal at 7 months of renal transplantation does not entail a higher risk in terms of HLA-Abs development in patients without pretransplant HLA-Abs and treatment with tacrolimus and MMF, although larger studies are needed to confirm these findings.

Keywords: Anti-HLA-antibodies; Anticuerpos anti-HLA; Corticoides; Immunosuppression; Inmunosupresión; Kidney transplantation; Retirada; Steroids; Trasplante renal; Withdrawal.