Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation : A Multicenter Study

Medientyp: E-Artikel
Titel: Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation : A Multicenter Study : A Multicenter Study
Beteiligte: Ziemann, Malte; Altermann, Wolfgang; Angert, Katharina; Arns, Wolfgang; Bachmann, Anette; Bakchoul, Tamam; Banas, Bernhard; von Borstel, Annette; Budde, Klemens; Ditt, Vanessa; Einecke, Gunilla; Eisenberger, Ute; Feldkamp, Thorsten; Görg, Siegfried; Guthoff, Martina; Habicht, Antje; Hallensleben, Michael; Heinemann, Falko M.; Hessler, Nicole; Hugo, Christian; Kaufmann, Matthias; Kauke, Teresa; Koch, Martina; König, Inke R.; [...]
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2019
Erschienen in: Clinical Journal of the American Society of Nephrology
Sprache: Englisch
DOI: 10.2215/cjn.13401118
ISSN: 1555-9041; 1555-905X
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Beschreibung: <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>The outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Pretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; <jats:italic toggle="yes">P<</jats:italic>0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; <jats:italic toggle="yes">P</jats:italic>=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; <jats:italic toggle="yes">P</jats:italic>=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Preformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.</jats:p> </jats:sec>
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