A paired kidney analysis on the impact of pre-transplant anti-HLA antibodies on graft survival.

Autor:	Michielsen LA; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Wisse BW; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Kamburova EG; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Verhaar MC; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Joosten I; Laboratory Medicine, Lab Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands., Allebes WA; Laboratory Medicine, Lab Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands., van der Meer A; Laboratory Medicine, Lab Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands., Hilbrands LB; Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Baas MC; Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Spierings E; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Hack CE; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., van Reekum FE; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Bots ML; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Drop ACAD; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Plaisier L; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Seelen MAJ; Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Sanders JF; Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Hepkema BG; Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Lambeck AJ; Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Bungener LB; Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Roozendaal C; Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Tilanus MGJ; Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands., Voorter CE; Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands., Wieten L; Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands., van Duijnhoven EM; Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands., Gelens M; Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands., Christiaans MHL; Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands., van Ittersum FJ; Department of Nephrology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands., Nurmohamed SA; Department of Nephrology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands., Lardy NM; Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands., Swelsen W; Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands., van der Pant KA; Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands., van der Weerd NC; Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands., Ten Berge IJM; Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands., Bemelman FJ; Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands., Hoitsma A; Dutch Organ Transplant Registry (NOTR), Dutch Transplant Foundation (NTS), Leiden, The Netherlands., van der Boog PJM; Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands., de Fijter JW; Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands., Betjes MGH; Department of Nephrology, Rotterdam, The Netherlands., Heidt S; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands., Roelen DL; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands., Claas FH; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands., Otten HG; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., van Zuilen AD; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2019 Jun 01; Vol. 34 (6), pp. 1056-1063.
DOI:	10.1093/ndt/gfy316
Abstrakt:	Background: Pre-transplant donor-specific anti-human leucocyte antigen (HLA) antibodies (DSAs) are associated with impaired kidney graft survival while the clinical relevance of non-donor-specific anti-HLA antibodies (nDSAs) is more controversial. The aim of the present paired kidney graft study was to compare the clinical relevance of DSAs and nDSAs. Methods: To eliminate donor and era-dependent factors, a post hoc paired kidney graft analysis was performed as part of a Dutch multicentre study evaluating all transplantations between 1995 and 2005 with available pre-transplant serum samples. Anti-HLA antibodies were detected with a Luminex single-antigen bead assay. Results: Among 3237 deceased donor transplantations, we identified 115 recipient pairs receiving a kidney from the same donor with one recipient being DSA positive and the other without anti-HLA antibodies. Patients with pre-transplant DSAs had a significantly lower 10-year death-censored graft survival (55% versus 82%, P=0.0001). We identified 192 pairs with one recipient as nDSA positive (against Class I and/or II) and the other without anti-HLA antibodies. For the patients with nDSAs against either Class I or II, graft survival did not significantly differ compared with patients without anti-HLA antibodies (74% versus 77%, P = 0.79). Only in patients with both nDSAs Class I and II was there a trend towards a lower graft survival (58%, P = 0.06). Lastly, in a small group of 42 recipient pairs, 10-year graft survival in recipients with DSAs was 49% compared with 68% in recipients with nDSAs (P=0.11). Conclusion: This paired kidney analysis confirms that the presence of pre-transplant DSAs in deceased donor transplantations is a risk marker for graft loss, whereas nDSAs in general are not associated with a lower graft survival. Subgroup analysis indicated that only in broadly sensitized patients with nDSAs against Class I and II, nDSAs may be a risk marker for graft loss in the long term. (© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu