Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 12, Issue 5, Pages 1157-1167Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1600-6143.2012.04013.x
Keywords
Antibody-mediated rejection; donor-specific antibody; kidney transplant; transplant rejection; subclinical AMR; nonadherence
Categories
Funding
- Canadian Institutes of Health Research
- Manitoba Medical Services Foundation
- Manitoba Health Research Council
- University of Manitoba Department of Medicine
- KRESCENT
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The natural history for patients with de novo donor-specific antibodies (dnDSA) and the risk factors for its development have not been well defined. Furthermore, clinical and histologic correlation with serologic data is limited. We studied 315 consecutive renal transplants without pretransplant DSA, with a mean follow-up of 6.2 +/- 2.9 years. Protocol (n = 215) and for cause (n = 163) biopsies were analyzed. Solid phase assays were used to screen for dnDSA posttransplant. A total of 47 out of 315 (15%) patients developed dnDSA at a mean of 4.6 +/- 3.0 years posttransplant. Independent predictors of dnDSA were HLA-DR beta 1 MM > 0 (OR 5.66, p < 0.006); and nonadherence (OR 8.75, p < 0.001); with a strong trend toward clinical rejection episodes preceding dnDSA (OR 1.57 per rejection episode, p = 0.061). The median 10-year graft survival for those with dnDSA was lower than the No dnDSA group (57% vs. 96%, p < 0.0001). Pathology consistent with antibody-mediated injury can occur and progress in patients with dnDSA in the absence of graft dysfunction and furthermore, nonadherence and cellular rejection contribute to dnDSA development and progression to graft loss.
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