The detrimental effect of donor-specific antibodies is irrespective of its level in highly-immunized living donor kidney transplant recipients: A case-control series

T Tramper; D L Roelen; S H Brand-Schaaf; J A Kal-van Gestel; M M L Kho; M E J Reinders; J I Roodnat; J van de Wetering; M G H Betjes; A E de Weerd

doi:10.3389/fimmu.2022.1093359

The detrimental effect of donor-specific antibodies is irrespective of its level in highly-immunized living donor kidney transplant recipients: A case-control series

Front Immunol. 2023 Jan 10:13:1093359. doi: 10.3389/fimmu.2022.1093359. eCollection 2022.

Authors

Affiliations

¹ Erasmus Medical Center Transplant Institute, Department of Internal Medicine, University Medical Center Rotterdam, Rotterdam, Netherlands.
² HLA Laboratory, Department of Immunology, Leiden University Medical Center, Leiden, Netherlands.

Abstract

Background: The impact of donor-specific antibodies (DSA) in (highly-) immunized living donor kidney transplant recipients is reported differentially in various patient cohorts.

Methods: We have performed a retrospective analysis of all consecutive HLA-incompatible living donor kidney transplant recipients in our center between 2010-2019. Recipients who underwent plasmafiltration for a positive CDC-crossmatch were excluded. For each DSA+ recipient (DSA+), one immunized recipient without DSA (pPRA+) and two non-immunized recipients (pPRA-) were included. Patient and graft survival were analyzed and a subgroup analysis of DSA+ recipients was performed.

Results: For 63 DSA+ recipients, 63 PRA+ and 126 PRA- recipients were included. 26 (41%) had class I, 24 (38%) class II and 13 (21%) combined HLA class I and II DSA. Death-censored graft survival was inferior in DSA+ recipients compared to pPRA+ (HR 2.38 [95% CI 1.00-5.70]) as well as to pPRA- (HR 3.91 [1.86-8.22]). In multivariate analysis, DSA remained of negative influence on death-censored graft survival. Flowcytometric crossmatch, MFI value, HLA class and origin of DSA were not of significant impact.

Conclusion: In our cohort of (highly-) immunized recipients, pretransplant DSA led to inferior death-censored graft survival. There were no "safe" DSA characteristics since only DSA per se impacted death-censored graft survival.

Keywords: antibody-mediated (ABMR); donor-specific antibodies; graft survival; kidney transplantation; panel-reactive antibodies.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antibodies
HLA Antigens
Humans
Kidney Transplantation* / adverse effects
Living Donors*
Retrospective Studies

Substances

HLA Antigens
Antibodies

Grants and funding

Unrestricted or unconditional grant by HANSA Biopharma AB. Statement to contract number 001825. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.