Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

被引：57

作者：

Kamburova, E. G. ^{[1
]}

Wisse, B. W. ^{[1
]}

Joosten, I. ^{[2
]}

Allebes, W. A. ^{[2
]}

van der Meer, A. ^{[2
]}

Hilbrands, L. B. ^{[3
]}

Baas, M. C. ^{[3
]}

Spierings, E. ^{[1
]}

Hack, C. E. ^{[1
]}

van Reekum, F. E. ^{[4
]}

van Zuilen, A. D. ^{[4
]}

Verhaar, M. C. ^{[4
]}

Bots, M. L. ^{[5
]}

Drop, A. C. A. D. ^{[1
]}

Plaisier, L. ^{[1
]}

Seelen, M. A. J. ^{[6
]}

Sanders, J. S. F. ^{[6
]}

Hepkema, B. G. ^{[7
]}

Lambeck, A. J. A. ^{[7
]}

Bungener, L. B. ^{[7
]}

Roozendaal, C. ^{[7
]}

Tilanus, M. G. J. ^{[8
]}

Voorter, C. E. ^{[8
]}

Wieten, L. ^{[8
]}

van Duijnhoven, E. M. ^{[9
]}

Gelens, M. ^{[9
]}

Christiaans, M. H. L. ^{[9
]}

van Ittersum, F. J. ^{[10
]}

Nurmohamed, S. A. ^{[10
]}

Lardy, N. M. ^{[11
]}

Swelsen, W. ^{[11
]}

van der Pant, K. A. ^{[12
]}

van der Weerd, N. C. ^{[12
]}

ten Berge, I. J. M. ^{[12
]}

Bemelman, F. J. ^{[12
]}

Hoitsma, A. ^{[13
]}

van der Boog, P. J. M. ^{[14
]}

de Fijter, J. W. ^{[14
]}

Betjes, M. G. H. ^{[15
]}

Heidt, S. ^{[16
]}

Roelen, D. L. ^{[16
]}

Claas, F. H. ^{[16
]}

Otten, H. G. ^{[1
]}

机构：

[1] Univ Med Ctr Utrecht, Lab Translat Immunol, Utrecht, Netherlands

[2] Radboud Univ Nijmegen, Lab Med, Lab Med Immunol, Med Ctr, Nijmegen, Netherlands

[3] Radboud Univ Nijmegen, Dept Nephrol, Med Ctr, Nijmegen, Netherlands

[4] Univ Med Ctr Utrecht, Dept Hypertens & Nephrol, Utrecht, Netherlands

[5] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[6] Univ Groningen, Univ Med Ctr Groningen, Dept Nephrol, Groningen, Netherlands

[7] Univ Groningen, Univ Med Ctr Groningen, Dept Lab Med, Groningen, Netherlands

[8] Maastricht Univ, Dept Transplantat Immunol, Tissue Typing Lab, Med Ctr, Maastricht, Netherlands

[9] Maastricht Univ, Dept Internal Med, Div Nephrol, Med Ctr, Maastricht, Netherlands

[10] Vrije Univ Amsterdam Med Ctr, Dept Nephrol, Amsterdam, Netherlands

[11] Sanquin, Dept Immunogenet, Amsterdam, Netherlands

[12] Acad Med Ctr, Renal Transplant Unit, Dept Internal Med, Amsterdam, Netherlands

[13] Dutch Transplant Fdn NTS, Dutch Organ Transplant Registry NOTR, Leiden, Netherlands

[14] Leiden Univ, Dept Nephrol, Med Ctr, Leiden, Netherlands

[15] Erasmus MC, Dept Internal Med, Nephrol, Rotterdam, Netherlands

[16] Leiden Univ, Dept Immunohematol & Blood Transfus, Med Ctr, Leiden, Netherlands

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2018年 / 18卷 / 09期

关键词：

alloantibody; clinical research; practice; graft survival; kidney failure; injury; kidney transplantation; nephrology; living donor; HIGHLY SENSITIZED PATIENTS; HUMAN-LEUKOCYTE ANTIGEN; LONG-TERM OUTCOMES; KIDNEY-TRANSPLANTATION; CROSS-MATCH; RENAL-TRANSPLANTATION; SINGLE-CENTER; GRAFT LOSS; REJECTION; RISK;

D O I：

10.1111/ajt.14709

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence. Via a retrospective multicenter study, the authors investigate the impact of pretransplant donor-specific HLA antibodies on long-term graft survival in deceased and living donor kidney transplantations.

引用

页码：2274 / 2284

页数：11

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