Journal
TRANSPLANT INTERNATIONAL
Volume 34, Issue 10, Pages 1824-1836Publisher
WILEY
DOI: 10.1111/tri.13964
Keywords
aABMR(h); HLA-DSA; joint modeling; kidney transplantation
Categories
Funding
- Research Foundation Flanders (FWO) [1844019N, 1842919N, 1143919N, IWT.150199]
- Flanders Innovation & Entrepreneurship agency (VLAIO) [IWT.150199]
- KU Leuven [C32/17/049]
Ask authors/readers for more resources
The presence of pretransplant HLA-DSA in kidney transplant patients increases the likelihood of developing aABMRh, cg, and aABMRh/cg, leading to a negative impact on graft survival. In patients without HLA-DSA, aABMR(h) associated with impaired graft outcome when evolving to cg.
The interplay between donor-specific anti-HLA antibodies (HLA-DSA), histology of active antibody-mediated rejection (aABMR(h)), transplant glomerulopathy (cg), and graft failure in kidney transplantation remains insufficiently understood. We performed a single-center cohort study (n = 1000) including 2761 protocol and 833 indication biopsies. Patients with pretransplant HLA-DSA were more prone to develop aABMRh (OR 22.7, 95% CI, 11.8-43.7, P < 0.001), cg (OR 5.76, 95% CI, 1.67-19.8, P = 0.006), and aABMRh/cg (OR 19.5, 95% CI, 10.6-35.9, P < 0.001). The negative impact of pre-transplant HLA-DSA on graft survival (HR 2.12, 95% CI, 1.41-3.20, P < 0.001) was partially mediated through aABMRh and cg occurrence. When adjusted for time-dependent HLA-DSA (HR 4.03, 95% CI, 2.21-7.15, P = 0.002), graft failure was only affected by aABMR(h) when cg was evident. In HLA-DSA negative patients, aABMR(h) was associated with impaired graft outcome only when evolving to cg (HR 1.32, 95% CI, 1.07-1.61, P = 0.008). We conclude that the kinetics of HLA-DSA are important to estimate the rate of graft failure, and that histological follow-up is necessary to discover, often subclinical, ABMR and cg. In the absence of HLA-DSA, patients experience similar histological lesions and the evolution to transplant glomerulopathy associates with impaired graft outcome.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available