Post-transplant donor specific antibody is associated with poor kidney transplant outcomes only when combined with both T-cell–mediated rejection and non-adherence

Transplanting the Elderly: Mandatory Age- and Minimal Histocompatibility Matching

“…A recent study showed that DSAs in combination with other risk factors can be even more detrimental for graft function. In this study, DSAs were associated with an increased incidence of T cell mediated rejection (TCMR) and led to a three-fold increase in graft loss (37). Lemoine et al (16) showed that anti HLA antibodies are an independent risk factor for patient death and graft loss within the 1st year in patients older than 70 years.…”

Post-transplant donor-specific antibody and outcomes with T cell–mediated rejection and nonadherence

“…1 As Yin pointed out, we describe a strong association between the development of donor-specific antibody (DSA) post-transplant, histological diagnosis of T cell-mediated rejection (TCMR), and nonadherence to immunosuppression as assessed by calcinuerin inhibitor intrapatient variability. 2 We respectfully differ with Yin in his assessment of the results presented. In our article, we presented a logical sequence of analyses and arguments showing that (i) DSA was strongly associated with increased odds of TCMR, (ii) the combination of DSA and TCMR associates with poor graft outcomes when compared with either DSA or TCMR alone, and (iii) of the factors identified to be associated with DSAþTCMRþ, immunosuppression nonadherence defined by a high calcinuerin inhibitor intrapatient variability (>35%), which was potentially modifiable, was further explored.…”

“…Previous studies have also reported that nonadherence was associated with both DSA and graft survival. 2,3 Then, it is unclear whether it is nonadherence that leads to the development of DSA and TCMR, which then resulted in worse transplant outcomes. Clearly, IPV > 35% is a risk factor for both DSAþTCMRþ and graft loss.…”

Mechanisms of organ transplant injury mediated by B cells and antibodies: Implications for antibody-mediated rejection

“…Consistent with the notion that de novo DSA develops as a result of inadequate immunosuppression or nonadherence, recent reports suggest that the incidence of pure chronic ABMR is relatively rare while mixed T cell and antibody rejection is more frequently encountered 73,80 . When both donor‐specific T and B cell responses develop, only DSA is assessed clinically and its presence may simply indicate an overall more mature immune response, which may be more difficult to reverse by immunosuppression and where the allografts had incurred more damage and were unable to fully recover their function 81 .…”