Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study

Ziemann M, Altermann W, Angert K, Arns W, Bachmann A, Bakchoul T, Banas B, von Borstel A, Budde K, Ditt V, Einecke G, Eisenberger U, Feldkamp T, Görg S, Guthoff M, Habicht A, Hallensleben M, Heinemann FM, Hessler N, Hugo C, Kaufmann M, Kauke T, Koch M, König IR, Kurschat C, Lehmann C, Marget M, Mühlfeld A, Nitschke M, Pego da Silva L, Quick C, Rahmel A, Rath T, Reinke P, Renders L, Sommer F, Spriewald B, Staeck O, Stippel D, Süsal C, Thiele B, Zecher D, Lachmann N (2019)

Publication Type: Journal article

Publication year: 2019

Journal

DOI: 10.2215/CJN.13401118

Abstract

BACKGROUND AND OBJECTIVES: The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively. RESULTS: Pretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI. CONCLUSIONS: Preformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.

Involved external institutions

Klinikum rechts der Isar Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Klinikum Augsburg Germany (DE) Kliniken der Stadt Köln Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Universitätsklinikum Regensburg Germany (DE) Universitätsklinikum Essen Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Universitätsklinikum Tübingen Germany (DE) Universitätsklinikum Halle (Saale) Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Universitätsklinikum Köln Germany (DE) Deutsche Stiftung Organtransplantation Germany (DE) Westpfalz-Klinikum Germany (DE) Universitätsklinikum Leipzig Germany (DE)

How to cite

APA:

Ziemann, M., Altermann, W., Angert, K., Arns, W., Bachmann, A., Bakchoul, T.,... Lachmann, N. (2019). Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study. Clinical Journal of the American Society of Nephrology. https://doi.org/10.2215/CJN.13401118

MLA:

Ziemann, Malte, et al. "Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study." Clinical Journal of the American Society of Nephrology (2019).

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