TY - JOUR
T1 - Preformed donor-specific HLA antibodies in living and deceased donor transplantation: A multicenter study
AU - Ziemann, Malte
AU - Altermann, Wolfgang
AU - Angert, Katharina
AU - Arns, Wolfgang
AU - Bachmann, Anette
AU - Bakchoul, Tamam
AU - Banas, Bernhard
AU - von Borstel, Annette
AU - Budde, Klemens
AU - Ditt, Vanessa
AU - Einecke, Gunilla
AU - Eisenberger, Ute
AU - Feldkamp, Thorsten
AU - Görg, Siegfried
AU - Guthoff, Martina
AU - Habicht, Antje
AU - Hallensleben, Michael
AU - Heinemann, Falko M.
AU - Hessler, Nicole
AU - Hugo, Christian
AU - Kaufmann, Matthias
AU - Kauke, Teresa
AU - Koch, Martina
AU - König, Inke R.
AU - Kurschat, Christine
AU - Lehmann, Claudia
AU - Marget, Matthias
AU - Mühlfeld, Anja
AU - Nitschke, Martin
AU - da Silva, Luiza Pego
AU - Quick, Carmen
AU - Rahmel, Axel
AU - Rath, Thomas
AU - Reinke, Petra
AU - Renders, Lutz
AU - Sommer, Florian
AU - Spriewald, Bernd
AU - Staeck, Oliver
AU - Stippel, Dirk
AU - Süsal, Caner
AU - Thiele, Bernhard
AU - Zecher, Daniel
AU - Lachmann, Nils
PY - 2019/7/5
Y1 - 2019/7/5
N2 - Background and objectives The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation. Design, setting, participants, & measurements The outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A,-B,-C,-DRB1 and-DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively. Results Pretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI. Conclusions Preformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.
AB - Background and objectives The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation. Design, setting, participants, & measurements The outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A,-B,-C,-DRB1 and-DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively. Results Pretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI. Conclusions Preformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.
UR - http://www.scopus.com/inward/record.url?scp=85069273694&partnerID=8YFLogxK
U2 - 10.2215/CJN.13401118
DO - 10.2215/CJN.13401118
M3 - Journal articles
C2 - 31213508
AN - SCOPUS:85069273694
SN - 1555-9041
VL - 14
SP - 1056
EP - 1066
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 7
ER -
