Ziemann, Malte and Altermann, Wolfgang and Angert, Katharina and Arns, Wolfgang and Bachmann, Anette and Bakchoul, Tamam and Banas, Bernhard and von Borstel, Annette and Budde, Klemens and Ditt, Vanessa and Einecke, Gunilla and Eisenberger, Ute and Feldkamp, Thorsten and Goerg, Siegfried and Guthoff, Martina and Habicht, Antje and Hallensleben, Michael and Heinemann, Falko M. and Hessler, Nicole and Hugo, Christian and Kaufmann, Matthias and Kauke, Teresa and Koch, Martina and Koenig, Inke R. and Kurschat, Christine and Lehmann, Claudia and Marget, Matthias and Muehlfeld, Anja and Nitschke, Martin and da Silva, Luiza Pego and Quick, Carmen and Rahmel, Axel and Rath, Thomas and Reinke, Petra and Renders, Lutz and Sommer, Florian and Spriewald, Bernd and Staeck, Oliver and Stippel, Dirk and Suesal, Caner and Thiele, Bernhard and Zecher, Daniel and Lachmann, Nils (2019) Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 14 (7). pp. 1056-1066. ISSN 1555-9041, 1555-905X
Full text not available from this repository. (Request a copy)Abstract
Background and objectivesThe prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation.Design, setting, participants, & measurementsThe 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.ResultsPretransplant 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.ConclusionsPreformed 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INCOMPATIBLE KIDNEY-TRANSPLANTATION; INDUCTION THERAPY; CROSS-MATCH; ABO; RITUXIMAB; OUTCOMES; RISK; RECIPIENTS; EFFICACY; kidney transplantation; preformed HLA antibodies; graft survival; donor-specific HLA antibodies; ABO-incompatible transplantation; Incidence; Prognosis; Fluorescence; Tissue Donors; Antibodies; HLA-A Antigens; Retrospective Studies |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Abteilung für Nephrologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 03 Apr 2020 07:06 |
| Last Modified: | 03 Apr 2020 07:06 |
| URI: | https://pred.uni-regensburg.de/id/eprint/26650 |
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