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Pre-transplant soluble CD30 in combination with total DSA but not pre-transplant C1q-DSA predicts antibody-mediated graft loss in presensitized high-risk kidney transplant recipients

Presensitized kidney transplant recipients are at high-risk for early antibody-mediated rejection. We studied the impact of pre- and post-transplant donor-specific human leukocyte antigen (HLA) antibodies (DSA) and T-cell-activation on the occurrence of antibody-mediated rejection episodes (AMR) and...

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Main Authors: Schäfer, Sebastian Markus (Author) , Süsal, Caner (Author) , Opelz, Gerhard (Author) , Döhler, Bernd (Author) , Becker, Luis Eduardo (Author) , Klein, Katrin (Author) , Waldherr, Rüdiger (Author) , Schemmer, Peter (Author) , Beimler, Jörg (Author) , Zeier, Martin (Author) , Morath, Christian (Author) , Macher-Göppinger, Stephan (Author)
Format: Article (Journal)
Language:English
Published: 03 January 2016
In: HLA
Year: 2016, Volume: 87, Issue: 2, Pages: 89-99
ISSN:2059-2310
DOI:10.1111/tan.12735
Online Access:Verlag, Volltext: https://doi.org/10.1111/tan.12735
Verlag: https://onlinelibrary.wiley.com/doi/abs/10.1111/tan.12735
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Author Notes:S.M. Schaefer, C. Süsal, G. Opelz, B. Döhler, L.E. Becker, K. Klein, S. Sickmüller, R. Waldherr, S. Macher‐Goeppinger, P. Schemmer, J. Beimler, M. Zeier & C. Morath
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Summary:Presensitized kidney transplant recipients are at high-risk for early antibody-mediated rejection. We studied the impact of pre- and post-transplant donor-specific human leukocyte antigen (HLA) antibodies (DSA) and T-cell-activation on the occurrence of antibody-mediated rejection episodes (AMR) and graft loss (AMR-GL) in a unique cohort of 80 desensitized high-risk kidney transplant recipients. Patients with pre-transplant DSA demonstrated more AMR episodes than patients without DSA, but did not show a significantly increased rate of AMR-GL. The rates of AMR and AMR-GL were not significantly increased in patients with complement split product (C1q)-binding pre-transplant DSA. Pre-transplant C1q-DSA became undetectable post-transplant in 11 of 13 (85%) patients; 2 (18%) of these 11 patients showed AMR but no AMR-GL. In contrast, the post-transplant presence of C1q-DSA was associated with significantly higher rates of AMR (86 vs 33 vs 0%; P < 0.001) and AMR-GL (86 vs 0 vs 0%; log-rank P < 0.001) compared with post-transplant DSA without C1q-binding or the absence of DSA. Patients with both pre-transplant DSA and evidence of pre-transplant T-cell-activation as indicated by soluble CD30-positivity showed a significantly increased risk for AMR-GL [HR = 11.1, 95% confidence interval (CI) = 1.68-73.4; log-rank P = 0.013]. In these high-risk patients, AMR-GL was associated with total DSA in combination with T-cell-activation pre-transplant, and de novo or persistent C1q-binding DSA post-transplant.
Item Description:Gesehen am 29.11.2019
Physical Description:Online Resource
ISSN:2059-2310
DOI:10.1111/tan.12735

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