Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

E. G. Kamburova*, B. W. Wisse, I. Joosten, W. A. Allebes, A. van der Meer, L. B. Hilbrands, M. C. Baas, E. Spierings, C. E. Hack, F. E. van Reekum, A. D. van Zuilen, M. C. Verhaar, M. L. Bots, A. C. A. D. Drop, L. Plaisier, M. A. J. Seelen, J. S. F. Sanders, B. G. Hepkema, A. J. A. Lambeck, L. B. BungenerC. Roozendaal, M. G. J. Tilanus, C. E. Voorter, L. Wieten, E. M. van Duijnhoven, M. Gelens, M. H. L. Christiaans, F. J. van Ittersum, S. A. Nurmohamed, N. M. Lardy, W. Swelsen, K. A. van der Pant, N. C. van der Weerd, I. J. M. ten Berge, F. J. Bemelman, A. Hoitsma, P. J. M. van der Boog, J. W. de Fijter, M. G. H. Betjes, S. Heidt, D. L. Roelen, F. H. Claas, H. G. Otten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

35 Citations (Web of Science)

Abstract

The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence. Via a retrospective multicenter study, the authors investigate the impact of pretransplant donor-specific HLA antibodies on long-term graft survival in deceased and living donor kidney transplantations.
Original languageEnglish
Pages (from-to)2274-2284
Number of pages11
JournalAmerican Journal of Transplantation
Volume18
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018

Keywords

  • alloantibody
  • clinical research
  • practice
  • graft survival
  • kidney failure
  • injury
  • kidney transplantation
  • nephrology
  • living donor
  • HIGHLY SENSITIZED PATIENTS
  • HUMAN-LEUKOCYTE ANTIGEN
  • LONG-TERM OUTCOMES
  • KIDNEY-TRANSPLANTATION
  • CROSS-MATCH
  • RENAL-TRANSPLANTATION
  • SINGLE-CENTER
  • GRAFT LOSS
  • REJECTION
  • RISK

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