Risk of Antibody-Mediated Rejection in Kidney Transplant Recipients With Anti-HLA-C Donor-Specific Antibodies

Aubert, Olivier; Bories, Mathilde; Suberbielle, Caroline; Snanoudj, Renaud; Anglicheau, Dany; Rabant, Marion; Martinez, Frank; Scemla, Anne; Legendre, Christophe; Sberro-Soussan, Rébecca

doi:10.1111/ajt.12709

Cited by 40 publications

(29 citation statements)

References 15 publications

(20 reference statements)

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“…Our data reached similar results of these previous studies, confirming that DSA-Cw is associated with a similar incidence of AMR and impact on graft survival in comparison with “classical” DSA against class I[9,10]. …”

Section: Discussionsupporting

confidence: 91%

“…Even so, the median time of follow up was relatively short and may have underestimated the incidence of rejection. Aubert et al[9] evaluated retrospectively 22 renal transplant recipients with isolated antiHLA-Cw DSA at day 0 of renal transplant, comparing them with 88 allosensitized patients with no preformed DSA (control group), and followed for a period of 1 year. Acute AMR was diagnosed in six patients (27.3%) in patients with DSA-Cw vs 9% in those without DSA.…”

Section: Discussionmentioning

confidence: 99%

“…However when the MFI values increased from this value, also did the risk of AMR. Again, Aubert et al[9] in their retrospective study with 22 renal transplant recipients with preformed isolated antiHLA-Cw DSA, showed that the level of DSA at day 0 was predictive for AMR: Measurement of MFI was 4966 (978-17941) in the AMR group and 981 (530-8012) in the group of patients without AMR ( P = 0.017).…”

Section: Discussionmentioning

confidence: 99%

“…In 2012, Ling et al[5] showed that kidney transplantation in patients with isolated antiHLA-Cw antibodies was effective (no rejections occurred) when using induction treatment with anti-thymocyte globulin (ATG) and IVIG. Another study evaluated 22 patients with pretransplant DSA antiHLA-Cw in comparison with 88 patients allosensitized but with no detectable preformed DSA and concluded that they seem to be at superior risk for AMR occurrence[9]. Recently, Bachelet et al[10] in their retrospective and multicenter study showed that antiHLA-Cw DSA have the same effect on graft outcome as DSA against “classical” HLA loci (A, B, DR, DQ), suggesting that antiHLA-Cw should also be considered in transplant allocation procedures and in immunologic risk stratification of patients.…”

Section: Introductionmentioning

confidence: 99%

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Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cwvsanti-A and/or -B antibodies

Santos¹,

Malheiro²,

Tafulo³

et al. 2016

WJT

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AIMTo analyze the clinical impact of preformed antiHLA-Cw vs antiHLA-A and/or -B donor-specific antibodies (DSA) in kidney transplantation.METHODSRetrospective study, comparing 12 patients transplanted with DSA exclusively antiHLA-Cw with 23 patients with preformed DSA antiHLA-A and/or B.RESULTSOne year after transplantation there were no differences in terms of acute rejection between the two groups (3 and 6 cases, respectively in the DSA-Cw and the DSA-A-B groups; P = 1). At one year, eGFR was not significantly different between groups (median 59 mL/min in DSA-Cw group, compared to median 51 mL/min in DSA-A-B group, P = 0.192). Moreover, kidney graft survival was similar between groups at 5-years (100% in DSA-Cw group vs 91% in DSA-A-B group, P = 0.528). The sole independent predictor of antibody mediated rejection (AMR) incidence was DSA strength (HR = 1.07 per 1000 increase in MFI, P = 0.034). AMR was associated with shortened graft survival at 5-years, with 75% and 100% grafts surviving in patients with or without AMR, respectively (Log-rank P = 0.005).CONCLUSIONOur data indicate that DSA-Cw are associated with an identical risk of AMR and impact on graft function in comparison with “classical” class I DSA.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cwvsanti-A and/or -B antibodies

Santos¹,

Malheiro²,

Tafulo³

et al. 2016

WJT

View full text Add to dashboard Cite

show abstract

“…4 Second, data on the clinical relevance of anti-HLACw antibodies are sparse. A retrospective casecontrol study of 22 patients with an isolated anti-HLA-Cw DSA at time of transplant reported an increased rate of antibody-mediated rejection, 5 although confirmation in a prospective study is awaited. Third, the role of non-HLA alloantigens is still being explored in solid-organ transplant.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

Exp Clin Transplant

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Use of induction therapy after kidney transplant is based on immunologic risk status, but accurate assessment of risk in the era of advanced immunologic testing can be complex. Here, we describe the case of a young kidney recipient who had a Castleman disease, often regarded as a benign lymphoma. Our patient, a white male patient with Castleman disease, underwent a first kidney transplant with rabbit antithymocyte globulin induction but returned to dialysis after primary nonfunction occurred. A second donor became available who shared 3 class I HLA antigens with the first donor, but only low-level isolated donor-specific antibodies toward HLA-Cw were detected (mean fluorescence intensity < 1000). After consideration by clinicians, the patient received a second transplant and was again given rabbit antithymocyte globulin induction (total dose 6 mg/kg). Graft biopsy at month 3 showed no evidence of microvascular inflammation, and the patient was C4d negative. At last follow-up (18 mo), serum creatinine level was 11 mg/dL and Castleman disease remained quiescent. In this challenging case, after weighing various factors concerning immunologic risk status and risk for posttransplant lymphoproliferative disease in the presence of Castleman disease, induction with rabbit antithymocyte globulin appeared to be the appropriate option. Patients with end-stage renal disease and quiescent Castleman disease should receive induction therapy, with close monitoring.

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HLA-typing analysis following allogeneic bone grafting for sinus lifting

et al. 2016

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According to the Brazilian Association of Organ Transplants, in 2015, 19,408 bone transplants were performed in Brazil, over 90% by Dental Surgeons. The surgical technique itself has a respectable number of reports regarding its clinical efficacy, as measured by long-term survival of dental implants in grafted areas. Uncertainty remains, however, as to whether fresh frozen grafts from human bone donors remain immunologically innocuous in the body of the host. Six male with no previous medical history of note, including systemic diseases, surgery or blood transfusion were selected. These patients underwent reconstructive procedures (sinus lifting) using fresh frozen human bone from a tissue bank. All patients had venous blood samples collected prior to surgery and 6 months after the procedure. Anti-HLA analysis for the detection of HLA (human leukocyte antigen) antibodies was performed using methods such as the LABScreen PRA Class I and Class II, LABScreen Single Antigen Class I and Class II, Luminex Platform. Reactive individuals to the screening tests (LABScreen PRA) were further investigated to determine the specificity of the antibodies detected (LABScreen Single Antigen) with a cutoff value of median fluorescence intensity ≥500. As a result, it was observed that two patients (33%) were positive in screening tests, one presenting with anti-HLA Class I and II sensitization and the other with anti-HLA class II. The specificity analysis showed that the patients sensitized to HLA class II presented 4 specificities, 3 of which immunologically relevant. In the second individual, 23 specificities were identified, 6 of which immunologically important for HLA class I and 4 specificities for HLA class II, 3 of these were immunologically important. All specificities detected had average fluorescence. These findings are suggestive that sinus-lifting procedures with allogeneic bone can induce immunological sensitization.

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Risk of Antibody-Mediated Rejection in Kidney Transplant Recipients With Anti-HLA-C Donor-Specific Antibodies

Cited by 40 publications

References 15 publications

Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cwvsanti-A and/or -B antibodies

Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cwvsanti-A and/or -B antibodies

Untitled

HLA-typing analysis following allogeneic bone grafting for sinus lifting

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