TY - JOUR
T1 - Pretransplant C3d-Fixing Donor-Specific Anti-HLA Antibodies Are Not Associated with Increased Risk for Kidney Graft Failure
AU - Kamburova, Elena G
AU - Wisse, Bram W
AU - Joosten, Irma
AU - Allebes, Wil A
AU - van der Meer, Arnold
AU - Hilbrands, Luuk B
AU - Baas, Marije C
AU - Spierings, Eric
AU - Hack, Cornelis E
AU - van Reekum, Franka E
AU - van Zuilen, Arjan D
AU - Verhaar, Marianne C
AU - Bots, Michiel L
AU - Drop, Adriaan C A D
AU - Plaisier, Loes
AU - Seelen, Marc A J
AU - Sanders, Jan Stephan
AU - Hepkema, Bouke G
AU - Lambeck, Annechien J A
AU - Bungener, Laura B
AU - Roozendaal, Caroline
AU - Tilanus, Marcel G J
AU - Voorter, Christina E
AU - Wieten, Lotte
AU - van Duijnhoven, Elly M
AU - Gelens, Mariëlle A C J
AU - Christiaans, Maarten H L
AU - van Ittersum, Frans J
AU - Nurmohamed, Shaikh A
AU - Lardy, Neubury M
AU - Swelsen, Wendy
AU - van der Pant, Karlijn A M I
AU - van der Weerd, Neelke C
AU - Ten Berge, Ineke J M
AU - Bemelman, Frederike J
AU - Hoitsma, Andries J
AU - van der Boog, Paul J M
AU - de Fijter, Johan W
AU - Betjes, Michiel G H
AU - Heidt, Sebastiaan
AU - Roelen, Dave L
AU - Claas, Frans H
AU - Otten, Henny G
N1 - Copyright © 2018 by the American Society of Nephrology.
PY - 2018/9
Y1 - 2018/9
N2 - Background Complement-fixing antibodies against donor HLA are considered a contraindication for kidney transplant. A modification of the IgG single-antigen bead (SAB) assay allows detection of anti-HLA antibodies that bind C3d. Because early humoral graft rejection is considered to be complement mediated, this SAB-based technique may provide a valuable tool in the pretransplant risk stratification of kidney transplant recipients.Methods Previously, we established that pretransplant donor-specific anti-HLA antibodies (DSAs) are associated with increased risk for long-term graft failure in complement-dependent cytotoxicity crossmatch-negative transplants. In this study, we further characterized the DSA-positive serum samples using the C3d SAB assay.Results Among 567 pretransplant DSA-positive serum samples, 97 (17%) contained at least one C3d-fixing DSA, whereas 470 (83%) had non-C3d-fixing DSA. At 10 years after transplant, patients with C3d-fixing antibodies had a death-censored, covariate-adjusted graft survival of 60%, whereas patients with non-C3d-fixing DSA had a graft survival of 64% (hazard ratio, 1.02; 95% confidence interval, 0.70 to 1.48 for C3d-fixing DSA compared with non-C3d-fixing DSA; P=0.93). Patients without DSA had a 10-year graft survival of 78%.Conclusions The C3d-fixing ability of pretransplant DSA is not associated with increased risk for graft failure.
AB - Background Complement-fixing antibodies against donor HLA are considered a contraindication for kidney transplant. A modification of the IgG single-antigen bead (SAB) assay allows detection of anti-HLA antibodies that bind C3d. Because early humoral graft rejection is considered to be complement mediated, this SAB-based technique may provide a valuable tool in the pretransplant risk stratification of kidney transplant recipients.Methods Previously, we established that pretransplant donor-specific anti-HLA antibodies (DSAs) are associated with increased risk for long-term graft failure in complement-dependent cytotoxicity crossmatch-negative transplants. In this study, we further characterized the DSA-positive serum samples using the C3d SAB assay.Results Among 567 pretransplant DSA-positive serum samples, 97 (17%) contained at least one C3d-fixing DSA, whereas 470 (83%) had non-C3d-fixing DSA. At 10 years after transplant, patients with C3d-fixing antibodies had a death-censored, covariate-adjusted graft survival of 60%, whereas patients with non-C3d-fixing DSA had a graft survival of 64% (hazard ratio, 1.02; 95% confidence interval, 0.70 to 1.48 for C3d-fixing DSA compared with non-C3d-fixing DSA; P=0.93). Patients without DSA had a 10-year graft survival of 78%.Conclusions The C3d-fixing ability of pretransplant DSA is not associated with increased risk for graft failure.
U2 - 10.1681/ASN.2018020205
DO - 10.1681/ASN.2018020205
M3 - Article
C2 - 30049681
SN - 1046-6673
VL - 29
SP - 2279
EP - 2285
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 9
ER -