A paired kidney analysis on the impact of pre-transplant anti-HLA antibodies on graft survival.
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Michielsen Laura A, Wisse Bram W, Kamburova Elena G, Verhaar Marianne C, Joosten Irma, Allebes Wil A, van der Meer Arnold, Hilbrands Luuk B, Baas Marije C, Spierings Eric, Hack Cornelis E, van Reekum Franka E, Bots Michiel L, Drop Adriaan C A D, Plaisier Loes, Seelen Marc A J, Sanders Jan-Stephan F, Hepkema Bouke G, Lambeck Annechien J, Bungener Laura B, Roozendaal Caroline, Tilanus Marcel G J, Voorter Christien E, Wieten Lotte, van Duijnhoven Elizabeth M, Gelens Mariëlle, Christiaans Maarten H L, van Ittersum Frans J, Nurmohamed Shaikh A, Lardy Neubury M, Swelsen Wendy, van der Pant Karlijn A, van der Weerd Neelke C, Ten Berge Ineke J M, Bemelman Frederike J, Hoitsma Andries, van der Boog Paul J M, de Fijter Johan W, Betjes Michiel G H, Heidt Sebastiaan, Roelen Dave L, Claas Frans H, Otten Henderikus G, van Zuilen Arjan D
Аннотация
METHODS: To eliminate donor and era-dependent factors, a post hoc paired kidney graft analysis was performed as part of a Dutch multicentre study evaluating all transplantations between 1995 and 2005 with available pre-transplant serum samples. Anti-HLA antibodies were detected with a Luminex single-antigen bead assay.
RESULTS: Among 3237 deceased donor transplantations, we identified 115 recipient pairs receiving a kidney from the same donor with one recipient being DSA positive and the other without anti-HLA antibodies. Patients with pre-transplant DSAs had a significantly lower 10-year death-censored graft survival (55% versus 82%, P=0.0001). We identified 192 pairs with one recipient as nDSA positive (against Class I and/or II) and the other without anti-HLA antibodies. For the patients with nDSAs against either Class I or II, graft survival did not significantly differ compared with patients without anti-HLA antibodies (74% versus 77%, P = 0.79). Only in patients with both nDSAs Class I and II was there a trend towards a lower graft survival (58%, P = 0.06). Lastly, in a small group of 42 recipient pairs, 10-year graft survival in recipients with DSAs was 49% compared with 68% in recipients with nDSAs (P=0.11).
CONCLUSION: This paired kidney analysis confirms that the presence of pre-transplant DSAs in deceased donor transplantations is a risk marker for graft loss, whereas nDSAs in general are not associated with a lower graft survival. Subgroup analysis indicated that only in broadly sensitized patients with nDSAs against Class I and II, nDSAs may be a risk marker for graft loss in the long term.