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Impact of pretransplant donor‐specific antibodies on kidney allograft recipients with negative flow cytometry cross‐matches
Author(s) -
Kwon Hyunwook,
Kim Young Hoon,
Choi Ji Yoon,
Shin Sung,
Jung Joo Hee,
Park SuKil,
Han Duck Jong
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13266
Subject(s) - medicine , hazard ratio , donor specific antibodies , kidney transplantation , gastroenterology , flow cytometry , incidence (geometry) , urology , transplantation , panel reactive antibody , immunology , confidence interval , physics , optics
The Luminex test can detect low levels of donor‐specific antibody ( DSA ) that cannot be detected by flow‐cytometric cross‐matching ( FCXM ) in kidney transplantation ( KT ). This study evaluated the impact of DSA on clinical outcomes in KT recipients negative on FCXM . Of 575 consecutive patients who underwent living donor KT between January 2013 and July 2016, 494 (85.9%) were DSA ‐negative and 81 (14.1%) were DSA ‐positive. Although rates of acute cellular rejection ( ACR ) at 1 year were similar in the 2 groups ( P = .54), the incidence of antibody‐mediated rejection ( ABMR ) was significantly higher in the DSA ‐positive group ( P < .01). There was no statistically significant association between rejection‐free graft survival ( RFGS ) rates and pretransplant class I DSA . However, evaluation of pretransplant class II DSA showed that RFGS rates were significantly lower in patients with mean fluorescence intensity ( MFI ) >3000 than in patients with DSA ‐negative ( P < .01). On multivariate analyses, class II DSA MFI ≥5000 was a significant risk factor for acute rejection (hazard ratio, 7.48; P < .01). These findings suggested that pretransplant DSA alone did not affect graft survival in KT recipients without desensitization. However, class II DSA MFI >5000 was an independent predictor of acute rejection in DSA ‐positive patients.