Toward a sensible single antigen bead cut-off based on kidney graft survival

Bram W Wisse, Elena G Kamburova, Irma Joosten, Wil A Allebes, Arnold van der Meer, Luuk B Hilbrands, Marije C Baas, Eric Spierings, Cornelis E Hack, Franka E van Reekum, Arjan D van Zuilen, Marianne C Verhaar, Michiel L Bots, Adriaan C A D Drop, Loes Plaisier, Marc A J Seelen, Jan Stephan Sanders, Bouke G Hepkema, Annechien J A Lambeck, Laura B BungenerCaroline Roozendaal, Marcel G J Tilanus, Christien E Voorter, Lotte Wieten, Elly M van Duijnhoven, Mariëlle A C J Gelens, Maarten H L Christiaans, Frans J van Ittersum, Shaikh A Nurmohamed, Junior N M Lardy, Wendy Swelsen, Karlijn A M I van der Pant, Neelke C van der Weerd, Ineke J M Ten Berge, Frederike J Bemelman, Andries J Hoitsma, Paul J M van der Boog, Johan W de Fijter, Michiel G H Betjes, Sebastiaan Heidt, Dave L Roelen, Frans H Claas, Henny G Otten

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BACKGROUND: There is no consensus in the literature on the interpretation of single antigen bead (SAB) positive for a specific HLA antibody.

METHODS: To inform the debate, we studied the relationship between various SAB positivity algorithms and the impact of resulting donor-specific HLA antibody (DSA) positivity on long-term kidney graft survival in 3237 deceased-donor transplants.

RESULTS: First, we showed that the interassay variability can be greatly reduced when working with signal-to-background ratios instead of absolute MFIs. Next, we determined pretransplant DSA using various MFI cut-offs, signal-to-background ratios (STBR) and combinations thereof. The impact of the various cut-offs was studied by comparing the graft survival between the DSA-positive and DSA-negative groups. We did not observe a strong impact of various cut-off levels on 10-year graft survival. A stronger relationship between the cut-off level and 1-year graft survival for DSA-positive transplants was found when using STBR, most pronounced for the bead of the same HLA-locus with lowest MFI taken as background.

CONCLUSIONS: With respect to pretransplant risk stratification, we propose a SBTR-6 (using the bead of the same HLA-locus with lowest MFI as background) cut-off of 15 combined with an MFI cut-off of 500, resulting in 8% and 21% lower 1- and 10-years graft survival, respectively, for 8% DSA positive transplants.

Original languageEnglish
Pages (from-to)789-797
Number of pages9
Issue number4
Publication statusPublished - 1-Apr-2019

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