American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2018
Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Kamburova E G, Wisse B W, Joosten I, Allebes W A, van der Meer A, Hilbrands L B, Baas M C, Spierings E, Hack C E, van Reekum F E, van Zuilen A D, Verhaar M C, Bots M L, Drop A C A D, Plaisier L, Seelen M A J, Sanders J S F, Hepkema B G, Lambeck A J A, Bungener L B, Roozendaal C, Tilanus M G J, Voorter C E, Wieten L, van Duijnhoven E M, Gelens M, Christiaans M H L, van Ittersum F J, Nurmohamed S A, Lardy N M, Swelsen W, van der Pant K A, van der Weerd N C, Ten Berge I J M, Bemelman F J, Hoitsma A, van der Boog P J M, de Fijter J W, Betjes M G H, Heidt S, Roelen D L, Claas F H, Otten H G
Аннотация
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.