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

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Perasaari , J P , Kyllonen , L E , Salmela , K T & Merenmies , J M 2016 , ' Pre-transplant donor-specific anti-human leukocyte antigen antibodies are associated with high risk of delayed graft function after renal transplantation ' , Nephrology, Dialysis, Transplantation , vol. 31 , no. 4 , pp. 672-678 . https://doi.org/10.1093/ndt/gfv391

Title: Pre-transplant donor-specific anti-human leukocyte antigen antibodies are associated with high risk of delayed graft function after renal transplantation
Author: Perasaari, Juha P.; Kyllonen, Lauri E.; Salmela, Kaija T.; Merenmies, Jussi M.
Contributor: University of Helsinki, Clinicum
University of Helsinki, Department of Surgery
University of Helsinki, Clinicum
Date: 2016-04
Language: eng
Number of pages: 7
Belongs to series: Nephrology, Dialysis, Transplantation
ISSN: 0931-0509
URI: http://hdl.handle.net/10138/163556
Abstract: Sensitive screening methods have revealed that many patients have donor-specific human leucocyte antigen antibodies (DSAs) prior to transplantation, regardless of negative crossmatch results. The clinical significance of pre-transplant (pre-Tx) DSAs for early graft function has remained unclear. Our aim was to examine the association of DSAs with delayed graft function (DGF). Pre-Tx sera of 771 patients who received kidney transplants in our single-centre study were retrospectively screened. All transplantations were performed after negative complement-dependent cytotoxicity (CDC) crossmatch. DSAs were detected in 13% of the patients. The overall DGF rate in our study was 29%. Patients with DSAs had a higher incidence of DGF when compared with non-sensitized patients (48 and 26%, respectively; P <0.0001). Third-party antibodies had no effect for DGF incidence (28%; P = 0.6098). The relative risk (RR) of DGF for patients with DSAs in the multivariate analysis was 2.039 (95% CI 1.246-3.335; P = 0.0046). Analyses of the cumulative mean fluorescent intensity (MFI) value of the DSAs revealed a rate of DGF more than two times higher in patients with a cumulative value of 3000-5000 MFI compared with a cumulative value of 1000-3000 (65 versus 31%; P = 0.0351). DSAs against any loci showed an elevated DGF incidence of 44-69% when compared with patients without DSA (27%). 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.
Subject: delayed graft function
dialysis
donor-specific antibody
graft survival
immunology
kidney transplantation
KIDNEY-TRANSPLANTATION
MULTIVARIATE-ANALYSIS
HLA ANTIBODIES
ACUTE REJECTION
SURVIVAL
ALLOGRAFT
OUTCOMES
CONSEQUENCES
RECIPIENTS
GLOBULIN
3126 Surgery, anesthesiology, intensive care, radiology
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