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Donor–Recipient Matching Based on Predicted Indirectly Recognizable HLA Epitopes Independently Predicts the Incidence of De Novo Donor‐Specific HLA Antibodies Following Renal Transplantation
Author(s) -
Lachmann N.,
Niemann M.,
Reinke P.,
Budde K.,
Schmidt D.,
Halleck F.,
Pruß A.,
Schönemann C.,
Spierings E.,
Staeck O.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14393
Subject(s) - epitope , human leukocyte antigen , medicine , kidney transplantation , transplantation , immunology , histocompatibility testing , antigen , antibody , proportional hazards model , incidence (geometry) , histocompatibility , isoantibodies , oncology , physics , optics
De novo donor‐specific HLA antibodies (dn DSA ) are recognized as a risk factor for premature allograft failure. Determinants of DSA specificity are generated via the indirect allorecognition pathway. Here, we present supportive data for the relevance of predicted indirectly recognizable HLA epitopes ( PIRCHE ) to predict dn DSA following kidney transplantation. A total of 2787 consecutive kidney transplants performed between 1995 and 2015 without preformed DSA have been analyzed. De novo DSA were detected by single antigen bead assay. HLA epitope mismatches were determined by the HLAM atchmaker and PIRCHE approach and correlated in uni‐ and multivariate analyses with 10‐year allograft survival and incidence of dn DSA . The PIRCHE ‐ II score moderately predicted allograft survival. However, the predictive value of elevated PIRCHE ‐ II scores >9 for the incidence of dn DSA was statistically significant (p < 0.001). In a multivariate Cox regression analysis adjusted for antigen mismatch and HLAM atchmaker epitopes, the PIRCHE ‐ II score could be identified as an independent risk factor for dn DSA . The PIRCHE ‐ II score independently from the antigen mismatch and HLAM atchmaker epitopes could be revealed as being a strong predictor for dn DSA . PIRCHE may help to identify acceptable mismatches with decreased risk of dn DSA and thus improve long‐term renal allograft survival.