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

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 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

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Abstract

The presence of donor-specific anti-HLA antibodies (DSA) is associated with increased risk of graft failure after kidney transplantation. We hypothesized that DSA against HLA class-I, -II or both indicate a different risk for graft loss between deceased- and living-donor transplantation. In this study we investigated the impact of pretransplant DSA, assessed using single antigen bead assays, on long-term graft survival in 3237 deceased- and 1487 living-donor kidney transplantations with a negative complement-dependent crossmatch. In living-donor transplantations, we found a limited effect on graft survival of DSA against class-I or -II antigens after transplantation. Class-I and -II DSA combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased-donor transplantation, patients with class-I or class-II DSA had a 10-year graft survival of 59% and 60% respectively, both significantly lower compared to patients without DSA (76%). The combination of class-I and -II DSA resulted in a 10-year survival of 54% in deceased-donor transplantations. In conclusion, class-I and -II DSA are a clear risk factor for graft loss in deceased-donor transplantations, while in living-donor transplantations class-I and -II DSA seem to be associated with an increased risk for graft failure but this could not be assessed due to their low prevalence. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)2274-2284
Number of pages11
JournalAmerican Journal of Transplantation
Volume18
Issue number9
Early online date21-Feb-2018
DOIs
Publication statusPublished - Sep-2018

Keywords

  • Journal Article
  • REJECTION
  • RISK
  • HIGHLY SENSITIZED PATIENTS
  • HUMAN-LEUKOCYTE ANTIGEN
  • LONG-TERM OUTCOMES
  • KIDNEY-TRANSPLANTATION
  • CROSS-MATCH
  • RENAL-TRANSPLANTATION
  • SINGLE-CENTER
  • GRAFT LOSS

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