Impact of de novo donor‐specific anti‐HLA antibodies on grafts outcomes in simultaneous pancreas–kidney transplantation. (25th September 2015)

• Record Type: Journal Article
• Authors: Malheiro, Jorge; Martins, La Salete; Tafulo, Sandra; Dias, Leonídio; Fonseca, Isabel; Beirão, Idalina; Castro‐Henriques, António; Cabrita, António
• Is Part Of: Transplant international. Volume 29:Number 2(2016)
• Page Start: 173
• Page End: 183
• Publication Date: 2015-09-25
• Subjects: antibodies anti‐HLA -- kidney transplant -- outcomes -- pancreas transplant -- survival -- type 1 diabetes; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.12687
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: De novo donor‐specific antibodies (dDSA) relevance in simultaneous pancreas–kidney (SPK) transplantation has been scarcely investigated. We analyzed dDSA relationship with grafts outcomes in a long‐term follow‐up SPK‐transplanted cohort. In 150 patients that received SPK transplant between 2000 and 2013, post‐transplant anti‐human leukocyte antigen (HLA) antibodies were screened and identified using Luminex‐based assays in sera collected at 3, 6, and 12 months, then yearly. dDSA were detected in 22 (14.7%) patients at a median 3.1 years after transplant. Pretransplant anti‐HLA sensitization (OR = 4.64), full HLA‐DR mismatch (OR = 4.38), and previous acute cellular rejection (OR = 9.45) were significant risk factors for dDSA. dDSA were significantly associated with kidney (in association with acute rejection) and pancreas graft failure. In dDSA+ patients, those with at least one graft failure presented more frequently dDSA against class II or I + II ( P = 0.011) and locus DQ ( P = 0.043) and had a higher median dDSA number ( P = 0.014) and strength ( P = 0.030). Median time between dDSA emergence and pancreas and kidney graft failure was 5 and 12 months, respectively. Emergence of dDSA increased the risk of grafts failure in SPK‐transplanted patients. Full HLA‐DR mismatch was associated with dDSA emergence. dDSA characteristics might help identify patients at a higher risk of graft failure.