The impact of pretransplant donor-specific antibodies on graft outcome in renal transplantation: a six-year follow-up study

Autor: Elias David-Neto, Patricia Soares Souza, Nicolas Panajotopoulos, Helcio Rodrigues, Carlucci Gualberto Ventura, Daisa Silva Ribeiro David, Francine Brambate Carvalhinho Lemos, Fabiana Agena, William Carlos Nahas, Jorge Elias Kalil, Maria Cristina Ribeiro Castro
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Zdroj: Clinics, Vol 67, Iss 4, Pp 355-361 (2012)
Druh dokumentu: article
ISSN: 1807-5932
1980-5322
DOI: 10.6061/clinics/2012(04)09
Popis: OBJECTIVE: The significance of pretransplant, donor-specific antibodies on long-term patient outcomes is a subject of debate. This study evaluated the impact and the presence or absence of donor-specific antibodies after kidney transplantation on short- and long-term graft outcomes. METHODS: We analyzed the frequency and dynamics of pretransplant donor-specific antibodies following renal transplantation from a randomized trial that was conducted from 2002 to 2004 and correlated these findings with patient outcomes through 2009. Transplants were performed against a complement-dependent T- and B-negative crossmatch. Pre- and posttransplant sera were available from 94 of the 118 patients (80%). Antibodies were detected using a solid-phase (LuminexH), single-bead assay, and all tests were performed simultaneously. RESULTS: Sixteen patients exhibited pretransplant donor-specific antibodies, but only 3 of these patients (19%) developed antibody-mediated rejection and 2 of them experienced early graft losses. Excluding these 2 losses, 6 of 14 patients exhibited donor-specific antibodies at the final follow-up exam, whereas 8 of these patients (57%) exhibited complete clearance of the donor-specific antibodies. Five other patients developed ''de novo'' posttransplant donor-specific antibodies. Death-censored graft survival was similar in patients with pretransplant donor-specific and non-donor-specific antibodies after a mean follow-up period of 70 months. CONCLUSION: Pretransplant donor-specific antibodies with a negative complement-dependent cytotoxicity crossmatch are associated with a risk for the development of antibody-mediated rejection, although survival rates are similar when patients transpose the first months after receiving the graft. Our data also suggest that early posttransplant donor-specific antibody monitoring should increase knowledge of antibody dynamics and their impact on long-term graft outcome.
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