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Renal Transplantation in Patients With Pre‐Transplant Donor‐Specific Antibodies and Negative Flow Cytometry Crossmatches
Author(s) -
Patel A. M.,
Pancoska C.,
Mulgaonkar S.,
Weng F. L.
Publication year - 2007
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/j.1600-6143.2007.01944.x
Subject(s) - medicine , transplantation , incidence (geometry) , flow cytometry , gastroenterology , antibody , renal transplant , creatinine , kidney transplantation , urology , immunology , physics , optics
The clinical significance of pre‐transplant donor‐specific antibodies (DSA), despite negative cytotoxicity and flow cytometry crossmatches (FCXMs), is unknown. We performed a retrospective cohort study of 60 living donor renal transplant recipients, all with pre‐transplant cytotoxicity and T‐cell and B‐cell FCXMs that were negative. Twenty recipients had pre‐transplant DSA detected by enzyme‐linked immunosorbent assays (ELISA) and/or microbead methods. Forty contemporaneous DSA‐negative controls were selected. In the DSA‐positive group, after a median follow‐up of 8.2 months (25–75% range, 5.4–22.8 months), patient survival was 100% and allograft survival was 95.0%. Acute humoral rejection (AHR) developed in four patients (20.0%). Three of the AHR episodes occurred within the first month post‐transplant. Median serum creatinine at last follow‐up was 1.3 mg/dL (25–75% range, 1.0–1.6 mg/dL), versus 1.1 mg/dL (25–75% range, 0.9–1.4 mg/dL) in the DSA‐negative controls (p = 0.29). Only one of the 40 controls developed AHR (2.5%). Pre‐transplant DSA was associated with a significantly increased incidence of AHR (p = 0.02 by log‐rank test). In conclusion, despite negative pre‐transplant cytotoxicity and FCXMs, renal transplant recipients with pre‐transplant DSA detected by solid‐phase methods may have an increased incidence of AHR and require close monitoring post‐transplant.