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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.

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