Influence of preoperative anti‐HLA antibodies on short‐ and long‐term graft survival in recipients with or without rituximab treatment

• Published in: Transplant international Vol. 27; no. 4; pp. 371 - 382
• Main Authors: Ishida, Hideki, Furusawa, Miyuki, Shimizu, Tomokazu, Nozaki, Taiji, Tanabe, Kazunari
• Format: Journal Article
• Language: English
• Published: England Frontiers Media SA 01.04.2014
• Subjects: acute antibody‐mediated rejection; Adult; Antibodies, Monoclonal, Murine-Derived - therapeutic use; anti‐HLA antibodies; B‐cell targeting protocol; B‐cell‐activating factor belonging to the tumor necrosis factor family; chronic antibody‐mediated rejection; de novo antibodies; desensitization protocol; Female; graft loss; Graft Rejection - etiology; Graft Rejection - immunology; Graft Survival - immunology; graft survival rate; HLA Antigens; Humans; Immunosuppressive Agents - therapeutic use; Isoantibodies - blood; Kidney Transplantation - adverse effects; Male; Middle Aged; Preoperative Period; renal transplantation; Retrospective Studies; Rituximab; Tissue Donors; de novo antibodies; desensitization protocol; chronic antibody-mediated rejection; graft loss; B-cell targeting protocol; renal transplantation; acute antibody-mediated rejection; graft survival rate; B-cell-activating factor belonging to the tumor necrosis factor family; anti-HLA antibodies; rituximab
• ISSN: 0934-0874; 1432-2277; 1432-2277
• DOI: 10.1111/tri.12267

Summary We investigated the relationship between preoperative anti‐HLA antibodies (donor‐specific antibody, DSA) and the graft survival rate in recipients who had or had not received rituximab (Rit) treatment. The subjects were categorized into four groups as follows: DSA+Rit−, n = 39; DSA−Rit−, n = 121; DSA+Rit+, n = 74; and DSA−Rit+, n = 47. We examined the influence of preoperative DSA on the incidence of graft rejection and the survival rate of recipients who had or who had not received rituximab before transplantation. The 6‐month acute rejection rates based on graft biopsies were 39%, 19%, 15%, and 0% for the DSA+Rit−, DSA−Rit−, DSA+Rit+, and DSA−Rit+ groups. The rates of chronic antibody‐mediated rejection after more than 6 months were 50%, 22%, 18%, and 0%. The 5‐year graft survival rate was significantly lower in the DSA+Rit− group (84%) than in the other groups (95% for DSA−Rit−, 98% for DSA+Rit+, and 91% for DSA−Rit+). The rate of the appearance of de novo anti‐HLA antibodies was higher in the groups that did not receive rituximab treatment. The rate of graft loss associated with chronic antibody‐mediated rejection was also higher in the DSA+Rit− group than in the other groups (P = 0.01). The presence of DSA and the administration of rituximab had strong impacts on not only short‐term graft rejection, but also long‐term graft rejection and its association with the graft survival time.