Clinical Relevance of Preformed HLA Donor-Specific Antibodies in Kidney Transplantation
Article first published online: 19 DEC 2007
American Journal of Transplantation
Volume 8, Issue 2, pages 324–331, February 2008
How to Cite
Lefaucheur, C., Suberbielle-Boissel, C., Hill, G. S., Nochy, D., Andrade, J., Antoine, C., Gautreau, C., Charron, D. and Glotz, D. (2008), Clinical Relevance of Preformed HLA Donor-Specific Antibodies in Kidney Transplantation. American Journal of Transplantation, 8: 324–331. doi: 10.1111/j.1600-6143.2007.02072.x
- Issue published online: 19 DEC 2007
- Article first published online: 19 DEC 2007
- Received 19 July 2007, revised 04 October 2007 and accepted for publication 22 October 2007
- Antibody-mediated rejection;
- clinical kidney transplantation;
- donor-specific antibodies;
- graft survival
This study analyzes the influence of preformed DSA, identified by HLA-specific ELISA assays, on graft survival and evaluates the incidence of antibody-mediated rejection (AMR) in patients with and without pregraft desensitization.
Kidney graft survival at 8 years was significantly worse in patients with DSA (n = 43) than in those without DSA (n = 194)(p = 0.03). The incidence of AMR in patients with DSA is 9-fold higher than in patients without DSA (p < 0.001) and their graft survival is significantly worse than in DSA patients without AMR and in non-DSA patients (p = 0.005). The prevalence for AMR in patients with DSA detected on historic serum is 32.3% in nondesensitized patients and 41.7% in desensitized patients. The risk for AMR is significantly more elevated in patients with strongly positive DSA (score 6–8) compared to those with DSA score 4 (p < 0.001), and in patients with historic DSA+/CXM+ compared to those with DSA+/CXM− (p = 0.01).
The presence of preformed DSA is strongly associated with graft loss in kidney transplants, related to an increased risk of AMR. Our findings demonstrate the importance of detection and characterization of DSA before transplantation. Stratification of this risk could be used to determine kidney allocation and to devise specific strategies for these patients.