Pre-transplant donor-specific anti-human leukocyte antigen antibodies are associated with high risk of delayed graft function after renal transplantation

Abstract

The risk of DGF is twice as high in patients having pre-formed DSAs. Pre-Tx DSAs is a modifiable risk factor that can be obviated with careful organ allocation relying on careful pre-Tx analysis of non-accepted mismatches determined with sensitive solid phase methods.

Early failure of kidney transplants in the current era-a national cohort study

“…Despite the very low risk of graft loss due to acute rejection, higher PRA levels were associated with an increased risk of graft loss. Some evidence associates previous sensitization as a risk factor for delayed graft function , and this could similarly contribute to primary nonfunction, seen in 0.6% of patients in the current study. The data about the presence of donor‐specific antibodies were unfortunately unavailable for this registry study, which limits our analyses.…”

Allosensitization after transplant failure: the role of graft nephrectomy and immunosuppression – a retrospective study

“…Re‐transplantation remains the ideal treatment for patients returning to dialysis after graft failure . It is therefore crucial to limit the burden of pretransplant allosensitization which is linked to detrimental graft outcomes and increased mortality , and aim to re‐transplant the patient with a favorably matched graft . Transplant nephrectomy has been associated with the early development of HLA antibodies, which variably persist in time .…”

“…The significance of this relates to the fact that previous reports have included patients who were DSA positive before the nephrectomy and patients with multiple renal transplants. These are additional variables shown to be associated with DSA development independent of nephrectomy or graft failure . Finally, the study time extended to 24 months allowed to capture a significant increase with time of the allosensitization also in the control group, which has important implications on re‐grafting and therefore on the decision of continuing the immunosuppression in patients who are candidates for re‐transplantation, especially if no living donor options are available.…”

“…In this group of patients re‐transplantation has been shown to reduce the mortality rate by up to 45% . Patients returning to dialysis after transplant failure often develop human leukocyte antigen (HLA) antibodies, which may preclude the opportunity of receiving a further transplant and are strongly associated with an increased risk of acute rejection and graft loss after re‐transplantation . Allograft nephrectomy is a known event leading to allosensitization and the formation of donor‐specific antibodies (DSA) .…”

Platelet donor selection for HLA‐immunised patients; the impact of donor‐specific HLA antibody levels

“…New technologies allow antibodies against specific HLA antigens to be distinguished individually. In solid organ and mismatched haematological stem cell transplant (HSCT) settings, HLA antibodies detected by these methods and directed against donor's antigens (donor‐specific antibodies, DSA) have repeatedly been shown to predict positive cross‐matching, rejection and delayed graft function (Ciurea et al ., ; Lefaucheur et al ., ; Riethmüller et al ., ; Spellman et al ., ; Caro‐Oleas et al ., ; BSHI & BTS, ; Piazza et al ., ; Peräsaari et al ., ; Kongtim et al ., ), but the significant antibody strength cut‐offs are not unequivocal. DSAs are also expected to be the main reason for immunologically mediated platelet refractoriness, but there are few studies on antibody strengths concerning the HLA antibodies of platelet refractory patients (Beligaswatte et al ., ; Jackman et al ., ) and even fewer utilising single antigen assays (Pai et al ., ).…”