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Anti‐HLA Donor‐Specific Antibodies Detected in Positive B‐Cell Crossmatches by Luminex ® Predict Late Graft Loss
Author(s) -
Eng H. S.,
Bennett G.,
Tsiopelas E.,
Lake M.,
Humphreys I.,
Chang S. H.,
Coates P. T. H.,
Russ G. R.
Publication year - 2008
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.1600-6143.2008.02387.x
Subject(s) - medicine , donor specific antibodies , immunology , antibody , human leukocyte antigen , antigen
The significance of B‐cell crossmatching in kidney transplantation is controversial. Recipients (n = 471) transplanted in a single centre from 1987 to 2005 with complete T‐ and B‐cell crossmatch records were studied. Sera from 83 patients transplanted across a positive B‐cell crossmatch, with concomitant negative T‐cell crossmatch (T–B+) on either current and/or peak sera were studied using Luminex ® to determine presence of donor‐specific antibodies (DSA). Clinical outcomes of T–B+ patients were compared with 386 T–B− patients. T–B+ predicted vascular (p = 0.01), but not cellular (p = 0.82) or glomerular (p = 0.14) rejection. IgG HLA DSA were found in 33% (n = 27) of the T–B+ patients and were associated with higher risk of any (p = 0.047), vascular (p = 0.01) or glomerular (p < 0.001) rejection at 6 months. Of 27 patients with DSA, 18/21 (86%) were the complement‐fixing IgG 1 and/or IgG 3 subclass antibodies. DSA imposed a statistically significant higher risk of graft loss 5 years posttransplant (1.8 [1.0–3.3], p = 0.045). This study showed that only one‐third of positive B‐cell crossmatch (BXM) was caused by DSA and was associated with late graft loss. Thus, using BXM to preclude kidney transplantation may potentially disadvantage >60% of patients in whom BXM is not indicative of the presence of DSA.