Class and Kinetics of Weakly Reactive Pretransplant Donor-specific HLA Antibodies Predict Rejection in Kidney Transplant Recipients

Alexander H. Morrison, Meera Gupta, Kelsey Lloyd, Jennifer Trofe-Clark, Mary Ann Lim, Christine Limonte, Matthew H. Levine, Deirdre Sawinski, Malek Kamoun, Paige M. Porrett

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background. The clinical impact of weakly reactive pretransplant donor-specific antibody (DSA) in kidney transplantation is controversial. While some evidence suggests that weakly reactive DSA can lead to rejection, it is unclear which patients are at risk for rejection and whether posttransplant changes in weakly reactive DSA are clinically meaningful. Methods. We retrospectively studied 80 kidney transplant recipients with weakly reactive pretransplant DSA between 2007 and 2014. We performed a multivariate Cox regression analysis to identify immunologic factors most associated with risk of biopsy-proven rejection. Results. Biopsy-proven rejection occurred in 13 of 80 (16%) patients. The presence of both class I and II DSA before transplant (hazards ratio 17.4, P < 0.01) and any posttransplant increase in DSA reactivity above a mean fluorescence intensity of 3000 (hazards ratio 7.8, P < 0.01) were each significantly associated with an increased risk of rejection, which primarily occurred within the first 18 months. Conclusions. Pretransplant DSA class and DSA kinetics after transplantation are useful prognostic indicators in patients with weak DSA reactivity. These results identify a small, high-risk patient group that warrants aggressive posttransplant DSA monitoring and may benefit from alternative donor selection.

Original languageEnglish
Article numbere478
JournalTransplantation Direct
Volume5
Issue number8
DOIs
StatePublished - Aug 1 2019

Bibliographical note

Publisher Copyright:
© 2019 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.

ASJC Scopus subject areas

  • Transplantation

Fingerprint

Dive into the research topics of 'Class and Kinetics of Weakly Reactive Pretransplant Donor-specific HLA Antibodies Predict Rejection in Kidney Transplant Recipients'. Together they form a unique fingerprint.

Cite this