| Literature DB >> 30049681 |
Elena G Kamburova1, Bram W Wisse2, Irma Joosten3, Wil A Allebes3, Arnold van der Meer3, Luuk B Hilbrands4, Marije C Baas4, Eric Spierings2, Cornelis E Hack2, Franka E van Reekum5, Arjan D van Zuilen5, Marianne C Verhaar5, Michiel L Bots6, Adriaan C A D Drop2, Loes Plaisier2, Marc A J Seelen7, Jan Stephan Sanders7, Bouke G Hepkema8, Annechien J A Lambeck8, Laura B Bungener8, Caroline Roozendaal8, Marcel G J Tilanus9, Christina E Voorter9, Lotte Wieten9, Elly M van Duijnhoven10, Mariëlle A C J Gelens10, Maarten H L Christiaans10, Frans J van Ittersum11, Shaikh A Nurmohamed11, Neubury M Lardy12, Wendy Swelsen12, Karlijn A M I van der Pant13, Neelke C van der Weerd13, Ineke J M Ten Berge13, Frederike J Bemelman13, Andries J Hoitsma14, Paul J M van der Boog7, Johan W de Fijter7, Michiel G H Betjes15,16, Sebastiaan Heidt17, Dave L Roelen17, Frans H Claas17, Henny G Otten2.
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.Entities:
Keywords: anti-HLA antibodies; chronic allograft failure; complement-fixing antibodies; kidney transplantation
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Year: 2018 PMID： 30049681 PMCID： PMC6115667 DOI： 10.1681/ASN.2018020205
Source DB: PubMed Journal: J Am Soc Nephrol ISSN： 1046-6673 Impact factor: 10.121