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Pre‐transplant soluble CD30 in combination with total DSA but not pre‐transplant C1q‐DSA predicts antibody‐mediated graft loss in presensitized high‐risk kidney transplant recipients
Author(s) -
Schaefer S. M.,
Süsal C.,
Opelz G.,
Döhler B.,
Becker L. E.,
Klein K.,
Sickmüller S.,
Waldherr R.,
MacherGoeppinger S.,
Schemmer P.,
Beimler J.,
Zeier M.,
Morath C.
Publication year - 2016
Publication title -
hla
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.347
H-Index - 99
eISSN - 2059-2310
pISSN - 2059-2302
DOI - 10.1111/tan.12735
Subject(s) - renal transplant , kidney transplant , donor specific antibodies , medicine , kidney , kidney transplantation , urology
Presensitized kidney transplant recipients are at high‐risk for early antibody‐mediated rejection. We studied the impact of pre‐ and post‐transplant donor‐specific human leukocyte antigen ( HLA ) antibodies ( DSA ) and T‐cell‐activation on the occurrence of antibody‐mediated rejection episodes ( AMR ) and graft loss ( AMR‐GL ) in a unique cohort of 80 desensitized high‐risk kidney transplant recipients. Patients with pre‐transplant DSA demonstrated more AMR episodes than patients without DSA , but did not show a significantly increased rate of AMR‐GL . The rates of AMR and AMR‐GL were not significantly increased in patients with complement split product (C1q)‐binding pre‐transplant DSA . Pre‐transplant C1q‐ DSA became undetectable post‐transplant in 11 of 13 (85%) patients; 2 (18%) of these 11 patients showed AMR but no AMR‐GL . In contrast, the post‐transplant presence of C1q‐ DSA was associated with significantly higher rates of AMR (86 vs 33 vs 0%; P < 0.001) and AMR‐GL (86 vs 0 vs 0%; log‐rank P < 0.001) compared with post‐transplant DSA without C1q‐binding or the absence of DSA . Patients with both pre‐transplant DSA and evidence of pre‐transplant T‐cell‐activation as indicated by soluble CD30 ‐positivity showed a significantly increased risk for AMR‐GL [ HR = 11.1, 95% confidence interval ( CI ) = 1.68–73.4; log‐rank P = 0.013]. In these high‐risk patients, AMR‐GL was associated with total DSA in combination with T‐cell‐activation pre‐transplant, and de novo or persistent C1q‐binding DSA post‐transplant.