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Reassessment of the clinical impact of preformed donor‐specific anti‐HLA‐Cw antibodies in kidney transplantation
Author(s) -
Visentin Jonathan,
Bachelet Thomas,
Aubert Olivier,
Del Bello Arnaud,
Martinez Charlie,
Jambon Frédéric,
Guidicelli Gwendaline,
Ralazamahaleo Mamy,
Bouthemy Charlène,
Cargou Marine,
CongyJolivet Nicolas,
g Thoa,
Lee JarHow,
SberroSoussan Rebecca,
Couzi Lionel,
Kamar Nassim,
Legendre Christophe,
Merville Pierre,
Taupin JeanLuc
Publication year - 2020
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.15766
Subject(s) - antibody , human leukocyte antigen , donor specific antibodies , transplantation , medicine , flow cytometry , antigen , kidney , immunology , histocompatibility , kidney transplantation , microbiology and biotechnology , biology
Anti‐denatured HLA‐Cw antibodies are highly prevalent, whereas anti‐native HLA‐Cw antibodies seem to lead to random flow cytometry crossmatch results. We aimed to reassess crossmatch prediction for anti‐HLA‐Cw using 2 types of single antigen flow beads (classical beads and beads with diminished expression of denatured HLA), and to compare the pathogenicity of preformed anti‐denatured and anti‐native HLA‐Cw antibodies in kidney transplantation. We performed 135 crossmatches with sera reacting against donor HLA‐Cw (classical beads fluorescence ≥500); only 20.6% were positive. Forty‐three (31.6%) were anti‐denatured HLA antibodies (beads with diminished expression of denatured HLA fluorescence <300); all were crossmatch negative. The correlation between classical beads fluorescence and the crossmatch ratio was low (ρ = 0.178), and slightly higher with beads with diminished expression of denatured HLA (ρ = 0.289). We studied 52 kidney recipients with preformed anti‐HLA‐Cw donor‐specific antibodies. Those with anti‐native HLA antibodies experienced more acute and chronic antibody‐mediated rejections ( P = .006 and .03, respectively), and displayed a lower graft survival ( P = .04). Patients with anti‐native HLA‐Cw antibodies more frequently had previous sensitizing events ( P < .1) or plausibility of their antibody profile according to known anti‐native HLA‐Cw eplets ( P = .0001). Anti‐native but not anti‐denatured HLA‐Cw antibodies are deleterious, which underscores the need for reagents with diminished expression of denatured HLA.