De novo donor-specific HLA antibodies reduce graft survival rates and increase the risk of kidney transplant rejection: A single-center retrospective study

Liu, Wei; Zhao, Jie; Kang, Zhong-Yu; Xiao, Yan-Li; Li, Yang; Liu, Chun; Li, Dai‐Hong

doi:10.1016/j.trim.2021.101430

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…univariable analysis, which, however, was not supported in the multivariable model, being in line with previous studies (27,43). The impact of the number of dnDSA per patient, independent of class, on graft survival is not known yet, since it has not been specifically analyzed in previous studies.…”

Section: Discussionsupporting

confidence: 62%

“…Non-adherence to treatment, under-immunosuppression, and graft inflammation are other factors that are related to dnDSA formation (29). It has been reported that the presence of both class I and II dnDSAs is more strongly related to graft failure, but few studies have specifically analyzed the long-term effects of antibody class (27, [37][38][39][40][41][42][43], and the impact of the number of dnDSA per patient on graft survival is unknown.…”

Section: Introductionmentioning

confidence: 99%

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The natural history of de novo donor-specific HLA antibodies after kidney transplantation

Cuesta

Naik

et al. 2022

Front. Med.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

The natural history of de novo donor-specific HLA antibodies after kidney transplantation

Cuesta

Naik

et al. 2022

Front. Med.

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“…These persistent de novo antibodies increased the incidence of post-transplantation aGvHD and severely affected patient survival. Our study results showed that HLA-II antibodies were the main de novo HLA antibody, which is consistent with the results of some organ transplantation studies ( 18 – 20 ). This finding is also consistent with our previous study on post-kidney transplantation de novo HLA antibodies, showing that post-transplantation de novo DSA antibodies were mainly HLA-II antibodies ( 21 ).…”

Section: Discussionsupporting

confidence: 93%

“…This finding is also consistent with our previous study on post-kidney transplantation de novo HLA antibodies, showing that post-transplantation de novo DSA antibodies were mainly HLA-II antibodies ( 21 ). Previous studies in organ transplantation ( 19 , 20 , 22 , 23 ) and our study have shown that de novo HLA antibodies will affect graft rejection and survival. Therefore, HLA antibodies should be monitored after transplantation, and we recommend that 1-month post-transplantation is the best test time point.…”

Section: Discussionsupporting

confidence: 59%

Posttransplant de novo DSA and NDSA affect GvHD, OS, and DFS after haplo-HSCT in patients without pre-existing HLA antibodies of hematological malignancies

et al. 2022

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To examine the production time, type, and MFI of post-transplantation de novo HLA antibodies, and their effects on haplo-HSCT outcomes, we retrospectively included 116 patients who were negative for pre-existing HLA antibodies. In total, 322 serum samples from pre-transplantation to post-transplantation were dynamically tested by Luminex and single-antigen bead reagents. Patients were divided into: HLA antibody persistently negative group (group 1), the de novo HLA antibody transiently positive group (group 2), the de novo HLA antibody non-persistently positive group (group 3), and the de novo HLA antibody persistently positive group (group 4). Group 4 included DSA+non-DSA (NDSA) (group 4a) and NDSA (group 4b) groups. The detection rate of de novo HLA antibodies was 75.9% (88/116). The median MFI for de novo HLA antibodies was 2439 (1033-20162). The incidence of II–IV aGvHD was higher in group 2 than in group 1 (52.6% vs 17.9%, P < 0.01); in group 4a than in group 1 (87.5% vs 17.9%, P < 0.001); and in group 4a than in group 4b (87.5% vs 40.0%, P = 0.001). The DFS (37.5% vs 85.7%, P < 0.01) and OS (37.5% vs 85.7%, P < 0.01) of group 4a were lower than those of group 1. The DFS (48.0% vs 85.7%, P < 0.01) and OS (56.0% vs 85.7%, P = 0.03) of group 4b were lower than those of group 1. Multivariate analysis showed that de novo HLA antibody being transiently positive (HR: 5.30; 95% CI: 1.71–16.42, P = 0.01) and persistently positive (HR: 5.67; 95% CI: 2.00–16.08, P < 0.01) were both associated with a higher incidence of II–IV aGvHD. Persistently positive de novo HLA antibodies were a risk factor for reduced DFS (HR: 6.57; 95% CI: 2.08–20.70, P < 0.01) and OS (HR: 5.51; 95% CI: 1.73–17.53, P < 0.01). DSA and NDSA can be detected since 15 days after haplo-HSCT in patients without pre-existing HLA antibodies, and affect aGvHD, DFS, and OS. Haplo-HSCT patients must be monitored for HLA antibodies changes for appropriate preventive clinical management, and we recommend that 1-month post-transplantation is the best test time point.

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“…Previous studies have shown that patients with ABMR more often have antibodies aimed at HLA class II, however this is also likely related to class II antibodies being the most commonly formed type. [ 22 , 92 , 131 ] Moreover, a recent large cohort study did not find any difference in the proportion of patients with HLA class I dnDSA who have underlying ABMR, as compared to class II dnDSA. [ 29 ] Additionally, dnDSA HLA-class specificity does not seem to be significantly associated with graft survival in multivariate analysis.…”

Section: Methodsmentioning

confidence: 99%

The Clinical Utility of Post-Transplant Monitoring of Donor-Specific Antibodies in Stable Renal Transplant Recipients: A Consensus Report With Guideline Statements for Clinical Practice

van den Broek,

Meziyerh,

Budde

et al. 2023

Transpl Int

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Solid phase immunoassays improved the detection and determination of the antigen-specificity of donor-specific antibodies (DSA) to human leukocyte antigens (HLA). The widespread use of SPI in kidney transplantation also introduced new clinical dilemmas, such as whether patients should be monitored for DSA pre- or post-transplantation. Pretransplant screening through SPI has become standard practice and DSA are readily determined in case of suspected rejection. However, DSA monitoring in recipients with stable graft function has not been universally established as standard of care. This may be related to uncertainty regarding the clinical utility of DSA monitoring as a screening tool. This consensus report aims to appraise the clinical utility of DSA monitoring in recipients without overt signs of graft dysfunction, using the Wilson & Junger criteria for assessing the validity of a screening practice. To assess the evidence on DSA monitoring, the European Society for Organ Transplantation (ESOT) convened a dedicated workgroup, comprised of experts in transplantation nephrology and immunology, to review relevant literature. Guidelines and statements were developed during a consensus conference by Delphi methodology that took place in person in November 2022 in Prague. The findings and recommendations of the workgroup on subclinical DSA monitoring are presented in this article.

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De novo donor-specific HLA antibodies reduce graft survival rates and increase the risk of kidney transplant rejection: A single-center retrospective study

Cited by 6 publications

References 27 publications

The natural history of de novo donor-specific HLA antibodies after kidney transplantation

The natural history of de novo donor-specific HLA antibodies after kidney transplantation

Posttransplant de novo DSA and NDSA affect GvHD, OS, and DFS after haplo-HSCT in patients without pre-existing HLA antibodies of hematological malignancies

The Clinical Utility of Post-Transplant Monitoring of Donor-Specific Antibodies in Stable Renal Transplant Recipients: A Consensus Report With Guideline Statements for Clinical Practice

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