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Pretransplant C3d-Fixing Donor-Specific Anti-HLA Antibodies Are Not Associated with Increased Risk for Kidney Graft Failure.


ABSTRACT: 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.

SUBMITTER: Kamburova EG 

PROVIDER: S-EPMC6115667 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Pretransplant C3d-Fixing Donor-Specific Anti-HLA Antibodies Are Not Associated with Increased Risk for Kidney Graft Failure.

Kamburova Elena G EG   Wisse Bram W BW   Joosten Irma I   Allebes Wil A WA   van der Meer Arnold A   Hilbrands Luuk B LB   Baas Marije C MC   Spierings Eric E   Hack Cornelis E CE   van Reekum Franka E FE   van Zuilen Arjan D AD   Verhaar Marianne C MC   Bots Michiel L ML   Drop Adriaan C A D ACAD   Plaisier Loes L   Seelen Marc A J MAJ   Sanders Jan Stephan JS   Hepkema Bouke G BG   Lambeck Annechien J A AJA   Bungener Laura B LB   Roozendaal Caroline C   Tilanus Marcel G J MGJ   Voorter Christina E CE   Wieten Lotte L   van Duijnhoven Elly M EM   Gelens Mariëlle A C J MACJ   Christiaans Maarten H L MHL   van Ittersum Frans J FJ   Nurmohamed Shaikh A SA   Lardy Neubury M NM   Swelsen Wendy W   van der Pant Karlijn A M I KAMI   van der Weerd Neelke C NC   Ten Berge Ineke J M IJM   Bemelman Frederike J FJ   Hoitsma Andries J AJ   van der Boog Paul J M PJM   de Fijter Johan W JW   Betjes Michiel G H MGH   Heidt Sebastiaan S   Roelen Dave L DL   Claas Frans H FH   Otten Henny G HG  

Journal of the American Society of Nephrology : JASN 20180726 9


<b>Background</b> 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.<b>Methods</b> Previously, we established that pretransplant  ...[more]

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