Open AccessFactors at de novo donor‐specific antibody initial detection associated with allograft loss: a multicenter study
Author(s) -
Schinstock Carrie A.,
Dadhania Darshana M.,
Everly Matthew J.,
Smith Byron,
Gandhi Manish,
Farkash Evan,
Sharma Vijay K.,
SamaniegoPicota Milagros,
Stegall Mark D.
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13395
Subject(s) - medicine , immunosuppression , antibody , proportional hazards model , kidney transplantation , cohort , gastroenterology , retrospective cohort study , transplantation , immunology
Summary We aimed to evaluate patient factors including nonadherence and viral infection and de novo donor‐specific antibody (dn DSA ) characteristics [total immunoglobulin G (IgG), C1q, IgG3, and IgG4] as predictors of renal allograft failure in a multicenter cohort with dn DSA . We performed a retrospective observational study of 113 kidney transplant recipients with dn DSA and stored sera for analysis. Predictors of death‐censored allograft loss were assessed by Cox proportional modeling. Death‐censored allograft survival was 77.0% (87/113) during a median follow‐up of 2.2 ( IQR 1.2–3.7) years after dn DSA detection. Predictors of allograft failure included medication nonadherence [ HR 6.5 (95% CI 2.6–15.9)], prior viral infection requiring immunosuppression reduction [ HR 5.3 (95% CI 2.1–13.5)], IgG3 positivity [ HR 3.8 (95% CI 1.5, 9.3)], and time post‐transplant (years) until donor‐specific antibody ( DSA ) detection [ HR 1.2 (95% CI 1.0, 1.3)]. In the 67 patients who were biopsied at dn DSA detection, chronic antibody‐mediated rejection [ HR 11.4 (95% CI 2.3, 56.0)] and mixed rejection [ HR 7.4 (95% CI 2.2, 24.8)] were associated with allograft failure. We conclude that patient factors, including a history of viral infection requiring immunosuppression reduction or medication nonadherence, combined with DSA and histologic parameters must be considered to understand the risk of allograft failure in patients with dn DSA .