100.[20221128]The natural history of de novo donor-specific HLA antibo…
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Front Med (Lausanne)
. 2022 Sep 16;9:943502. doi: 10.3389/fmed.2022.943502. eCollection 2022.
The natural history of de novo donor-specific HLA antibodies after kidney transplantation
Covadonga López Del Moral 1 2, Kaiyin Wu 3, Marcel Naik 1, Bilgin Osmanodja 1, Aylin Akifova 1, Nils Lachmann 4, Diana Stauch 4, Sabine Hergovits 4, Mira Choi 1, Friederike Bachmann 1, Fabian Halleck 1, Eva Schrezenmeier 1 5, Danilo Schmidt 1, Klemens Budde 1
Affiliations expand
PMID: 36186822 PMCID: PMC9523126 DOI: 10.3389/fmed.2022.943502
Free PMC article
Abstract
Background: De novo donor-specific HLA antibodies (dnDSA) are key factors in the diagnosis of antibody-mediated rejection (ABMR) and related to graft loss.
Methods: This retrospective study was designed to evaluate the natural course of dnDSA in graft function and kidney allograft survival and to assess the impact of mean fluorescence intensity (MFI) evolution as detected by annual Luminex® screening. All 400 kidney transplant recipients with 731 dnDSA against the last graft (01/03/2000-31/05/2021) were included.
Results: During 8.3 years of follow-up, ABMR occurred in 24.8% and graft loss in 33.3% of the cases, especially in patients with class I and II dnDSA, and those with multiple dnDSA. We observed frequent changes in MFI with 5-year allograft survivals post-dnDSA of 74.0% in patients with MFI reduction ≥ 50%, 62.4% with fluctuating MFI (MFI reduction ≥ 50% and doubling), and 52.7% with doubling MFI (log-rank p < 0.001). Interestingly, dnDSA in 168 (24.3%) cases became negative at some point during follow-up, and 38/400 (9.5%) patients became stable negative, which was associated with better graft survival. Multivariable analysis revealed the importance of MFI evolution and rejection, while class and number of dnDSA were not contributors in this model.
Conclusion: In summary, we provide an in-depth analysis of the natural course of dnDSA after kidney transplantation, first evidence for the impact of MFI evolution on graft outcomes, and describe a relevant number of patients with a stable disappearance of dnDSA, related to better allograft survival.
Keywords: antibody-mediated rejection; donor-specific antibodies; graft failure; kidney transplantation; mean fluorescence intensity.
Front Med (Lausanne)
. 2022 Sep 16;9:943502. doi: 10.3389/fmed.2022.943502. eCollection 2022.
The natural history of de novo donor-specific HLA antibodies after kidney transplantation
Covadonga López Del Moral 1 2, Kaiyin Wu 3, Marcel Naik 1, Bilgin Osmanodja 1, Aylin Akifova 1, Nils Lachmann 4, Diana Stauch 4, Sabine Hergovits 4, Mira Choi 1, Friederike Bachmann 1, Fabian Halleck 1, Eva Schrezenmeier 1 5, Danilo Schmidt 1, Klemens Budde 1
Affiliations expand
PMID: 36186822 PMCID: PMC9523126 DOI: 10.3389/fmed.2022.943502
Free PMC article
Abstract
Background: De novo donor-specific HLA antibodies (dnDSA) are key factors in the diagnosis of antibody-mediated rejection (ABMR) and related to graft loss.
Methods: This retrospective study was designed to evaluate the natural course of dnDSA in graft function and kidney allograft survival and to assess the impact of mean fluorescence intensity (MFI) evolution as detected by annual Luminex® screening. All 400 kidney transplant recipients with 731 dnDSA against the last graft (01/03/2000-31/05/2021) were included.
Results: During 8.3 years of follow-up, ABMR occurred in 24.8% and graft loss in 33.3% of the cases, especially in patients with class I and II dnDSA, and those with multiple dnDSA. We observed frequent changes in MFI with 5-year allograft survivals post-dnDSA of 74.0% in patients with MFI reduction ≥ 50%, 62.4% with fluctuating MFI (MFI reduction ≥ 50% and doubling), and 52.7% with doubling MFI (log-rank p < 0.001). Interestingly, dnDSA in 168 (24.3%) cases became negative at some point during follow-up, and 38/400 (9.5%) patients became stable negative, which was associated with better graft survival. Multivariable analysis revealed the importance of MFI evolution and rejection, while class and number of dnDSA were not contributors in this model.
Conclusion: In summary, we provide an in-depth analysis of the natural course of dnDSA after kidney transplantation, first evidence for the impact of MFI evolution on graft outcomes, and describe a relevant number of patients with a stable disappearance of dnDSA, related to better allograft survival.
Keywords: antibody-mediated rejection; donor-specific antibodies; graft failure; kidney transplantation; mean fluorescence intensity.
