Pretransplant Donor‐Specific HLA Class‐I and ‐II Antibodies Are Associated With an Increased Risk for Kidney Graft Failure

• Published in: American journal of transplantation Vol. 12; no. 6; pp. 1618 - 1623
• Main Authors: Otten, H. G., Verhaar, M. C., Borst, H. P. E., Hené, R. J., Zuilen, A. D. van
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.06.2012; Wiley
• Subjects: Biological and medical sciences; C1q; donor specific antibodies; Donors; Fluorescence; Graft Rejection; Grafts; Histocompatibility antigen HLA; Histocompatibility Antigens Class I - immunology; Histocompatibility Antigens Class II - immunology; Histocompatibility testing; Humans; Immunoglobulin G; Kidney; Kidney Transplantation; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Rejection; Renal failure; Risk assessment; Risk Factors; single‐antigen bead array; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival; Kidney disease; Suboptimal donor; Human; C1q; Urinary system disease; donor specific antibodies; Antibody; Class II histocompatibility antigen; Risk; Complement C1q; Homotransplantation; Kidney; Graft failure; Association; Treatment; Urinary system; single-antigen bead array; Surgery; Risk factor; Renal failure; Graft; Preoperative; Class I histocompatibility antigen; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2011.03985.x

Pretransplant risk assessment of graft failure is important for donor selection and choice of immunosuppressive treatment. We examined the relation between kidney graft failure and presence of IgG donor specific HLA antibodies (DSA) or C1q‐fixing DSA, detected by single antigen bead array (SAB) in pretransplant sera from 837 transplantations. IgG‐DSA were found in 290 (35%) sera, whereas only 30 (4%) sera had C1q‐fixing DSA. Patients with both class‐I plus ‐II DSA had a 10 yr graft survival of 30% versus 72% in patients without HLA antibodies (p < 0.001). No significant difference was observed in graft survival between patients with or without C1q‐fixing DSA. Direct comparison of both assays showed that high mean fluorescence intensity values on the pan‐IgG SAB assay are generally related to C1q‐fixation. We conclude that the presence of class‐I plus ‐II IgG DSA as detected by SAB in pretransplant sera of crossmatch negative kidney recipients is indicative for an increased risk for graft failure, whereas the clinical significance of C1q‐fixing IgG‐DSA could not be assessed due to their low prevalence. In a retrospective analysis using pretransplant sera from 837 kidney transplantations, this study compares the value of C1q‐fixing versus pan‐IgG donor‐specific HLA antibodies in risk assessment for kidney graft failure.