Development and outcomes of de novo donor-specific antibodies in low, moderate, and high immunological risk kidney transplant recipients.
alloantibody
clinical research/practice
graft survival
kidney transplantation/nephrology
rejection
rejection: antibody-mediated (ABMR)
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
29
06
2019
revised:
24
11
2019
accepted:
01
12
2019
pubmed:
24
12
2019
medline:
22
6
2021
entrez:
24
12
2019
Statut:
ppublish
Résumé
De novo donor-specific antibodies (dnDSA) play an important role in antibody-mediated rejection (ABMR) and graft failure, yet their development in kidney transplant recipients (KTx) of higher immunological risk has not been characterized. We prospectively determined the incidence of dnDSA at 3 and 12 months posttransplant and assessed their associations with outcomes in recipients stratified by low, moderate, and high immunological risk. Adult KTx were screened for DSA pretransplant, months 3 and 12 posttransplant, and when clinically indicated. Outcomes included incidence of dnDSA, death-censored graft survival (DCGS), and ABMR. Of 371 recipients, 154 (42%) were transplanted across a pretransplant DSA that became undetectable by 12 months posttransplant in 78% of cases. dnDSA were detected in 16% (95% confidence interval [CI]: 12-20%) by 3 months and 23% (95% CI: 18-29%) by 12 months posttransplant. Incidence at 12 months was higher in the moderate (30%) and high-risk groups (29%) compared to the low-risk group (16%). dnDSA were associated with an increased risk of ABMR (hazard ratio [HR] 2.2; 95% CI: 1.1-4.4; P = .04) but were not an independent risk factor for DCGS. In conclusion, dnDSA were more frequent in transplant recipients of higher immune risk and associated with an increased risk of ABMR.
Identifiants
pubmed: 31867849
doi: 10.1111/ajt.15754
pii: S1600-6135(22)22320-X
doi:
Substances chimiques
HLA Antigens
0
Isoantibodies
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1351-1364Informations de copyright
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Matas AJ, Fieberg A, Mannon RB, et al. Long-term follow-up of the DeKAF cross-sectional cohort study. Am J Transplant. 2019;19(5):1432-1443.
Stegall MD, Gaston RS, Cosio FG, Matas A. Through a glass darkly: seeking clarity in preventing late kidney transplant failure. J Am Soc Nephrol. 2015;26(1):20-29.
Sellarés J, de Freitas DG, Mengel M, et al. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant. 2012;12(2):388-399.
Gaston RS, Cecka JM, Kasiske BL, et al. Evidence for antibody-mediated injury as a major determinant of late kidney allograft failure. Transplantation. 2010;90(1):68-74.
ANZDATA Registry. 41st Report, Chapter 7: Kidney Transplantation. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia. 2018. http://www.anzdata.org.au/.Accessed August 15, 2019.
Lefaucheur C, Loupy A, Hill GS, et al. Preexisting donor-specific HLA antibodies predict outcome in kidney transplantation. J Am Soc Nephrol. 2010;21(8):1398-1406.
Mohan S, Palanisamy A, Tsapepas D, et al. Donor-specific antibodies adversely affect kidney allograft outcomes. J Am Soc Nephrol. 2012;23(12):2061-2071.
Sicard A, Amrouche L, Suberbielle C, et al. Outcome of kidney transplantations performed with preformed donor-specific antibodies of unknown etiology. Am J Transplant. 2014;14(1):193-201.
Amrouche L, Aubert O, Suberbielle C, et al. Long-term outcomes of kidney transplantation in patients with high levels of preformed DSA: the necker high-risk transplant program. Transplantation. 2017;101(10):2440-2448.
Vo A, Aubert O, Haas M, et al. Clinical relevance of post transplant donor specific antibodies (DSAs) in patients receiving desensitisation for HLA incompatible kidney transplantation. Transplantation. 2019;103:2666-2674.
Wiebe C, Gibson IW, Blydt-Hansen TD, et al. Rates and determinants of progression to graft failure in kidney allograft recipients with de novo donor-specific antibody. Am J Transplant. 2015;15(11):2921-2930.
Wiebe C, Gibson IW, Blydt-Hansen TD, et al. Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. Am J Transplant. 2012;12(5):1157-1167.
Dieplinger G, Ditt V, Arns W, et al. Impact of de novo donor-specific HLA antibodies detected by Luminex solid-phase assay after transplantation in a group of 88 consecutive living-donor renal transplantations. Transpl Int. 2014;27(1):60-68.
Everly MJ, Rebellato LM, Haisch CE, et al. Incidence and impact of de novo donor-specific alloantibody in primary renal allografts. Transplantation. 2013;95(3):410-417.
Ginevri F, Nocera A, Comoli P, et al. Posttransplant de novo donor-specific HLA antibodies identify pediatric kidney recipients at risk for late antibody-mediated rejection. Am J Transplant. 2012;12(12):3355-3362.
Hirai T, Furusawa M, Omoto K, Ishida H, Tanabe K. Analysis of predictive and preventive factors for de novo DSA in kidney transplant recipients. Transplantation. 2014;98(4):443-450.
Viglietti D, Loupy A, Vernerey D, et al. Value of donor-specific anti-HLA antibody monitoring and characterization for risk stratification of kidney allograft loss. J Am Soc Nephrol. 2017;28(2):702-715.
Hricik DE, Formica RN, Nickerson P, et al. Adverse outcomes of tacrolimus withdrawal in immune-quiescent kidney transplant recipients. J Am Soc Nephrol. 2015;26(12):3114-3122.
Sharma A, Lewis JR, Lim WH, et al. Renal transplant outcomes and de novo donor-specific anti-human leukocyte antigen antibodies: a systematic review. Nephrol Dial Transplant. 2018;33(8):1472-1480.
Schinstock CA, Dadhania DM, Everly MJ, et al. Factors at de novo donor-specific antibody initial detection associated with allograft loss: a multicenter study. Transpl Int. 2019;32(5):502-515.
Tait BD, Süsal C, Gebel HM, et al. Consensus guidelines on the testing and clinical management issues associated with HLA and Non-HLA antibodies in transplantation. Transplantation. 2013;95(1):19-47.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
Davis S, Gralla J, Klem P, et al. Lower tacrolimus exposure and time in therapeutic range increase the risk of de novo donor-specific antibodies in the first year of kidney transplantation. Am J Transplant. 2018;18(4):907-915.
Ziemann M, Altermann W, Angert K, et al. Preformed donor-specific HLA antibodies in living and deceased donor transplantation: a multicenter study. Clin J Am Soc Nephrol. 2019;14(7):1056-1066.
de Weerd AE, Betjes MGH. ABO-incompatible kidney transplant outcomes: a meta-analysis. Clin J Am Soc Nephrol. 2018;13(8):1234-1243.
Tambur AR, Campbell P, Claas FH, et al. Sensitization in transplantation: assessment of risk (STAR) 2017 Working Group Meeting Report. Am J Transplant. 2018;18(7):1604-1614.
Chong AS, Ansari MJ. Heterogeneity of memory B cells. Am J Transplant. 2018;18(4):779-784.
Walters GD, Vinuesa CG. T follicular helper cells in transplantation. Transplantation. 2016;100(8):1650-1655.
Macedo C, Hadi K, Walters J, et al. Impact of induction therapy on circulating T follicular helper cells and subsequent donor-specific antibody formation after kidney transplant. Kidney International Reports. 2019;4:455-469.
Badell IR, Ford ML. T follicular helper cells in the generation of alloantibody and graft rejection. Curr Opin Organ Transplant. 2016;21(1):1-6.
Sapir-Pichhadze R, Wang Y, Famure O, Li Y, Kim SJ. Time-dependent variability in tacrolimus trough blood levels is a risk factor for late kidney transplant failure. Kidney Int. 2014;85(6):1404-1411.
Eskandary F, Regele H, Baumann L, et al. A randomized trial of bortezomib in late antibody-mediated kidney transplant rejection. J Am Soc Nephrol. 2018;29(2):591-605.
Jordan SC, Choi J, Kim I, et al. Interleukin-6, A cytokine critical to mediation of inflammation, autoimmunity and allograft rejection: therapeutic implications of IL-6 receptor blockade. Transplantation. 2017;101(1):32-44.
Lim WH, Chadban SJ, Clayton P, et al. Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients. Clin Transplant. 2012;26(4):E428-437.
Tambur AR, Claas FH. HLA epitopes as viewed by antibodies: what is it all about? Am J Transplant. 2015;15(5):1148-1154.
Wiebe C, Pochinco D, Blydt-Hansen TD, et al. Class II HLA epitope matching - a strategy to minimize de novo donor-specific antibody development and improve outcomes. Am J Transplant. 2013;13(12):3114-3122.