The results of HLA‐incompatible kidney transplantation according to pre‐transplant crossmatch tests: Donor‐specific antibody as a prominent predictor of acute rejection. Issue 5 (6th April 2019)

• Record Type: Journal Article
• Authors: Kwon, Hyunwook; Kim, Young Hoon; Kim, Jee Yeon; Choi, Ji Yoon; Shin, Sung; Jung, Joo Hee; Park, Su‐Kil; Han, Duck Jong
• Is Part Of: Clinical transplantation. Volume 33:Issue 5(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-04-06
• Subjects: allograft survival -- anti‐HLA antibodies -- donor‐specific antibodies -- kidney transplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.13533
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Background: Crossmatching (XM) between organ donors and recipients is correlated with clinical outcomes. This study evaluates the results of HLA‐incompatible kidney transplant (HLA‐i KT) according to pre‐transplant XM modalities. Methods: This study included 731 consecutive patients. HLA‐i KT was defined as a transplant under conditions of complement‐dependent cytotoxicity (CDC) XM positivity, flow‐cytometric XM (FCXM) positivity, and/or maximal donor‐specific antibody (DSA) mean fluorescence intensity (MFI) ≥5000. Results: The incidence of antibody‐mediated rejection (AMR) within 1 year after transplant was significantly higher in the HLA‐i group than in the HLA compatible (HLA‐c) group (15 vs 9 patients, 14.2% vs 1.4%; P < 0.01). Multivariate analysis indicated that a DSA MFI ≥5000 (odds ratio [OR] = 2.63; 95% confidence interval [CI], 1.00‐6.98; P = 0.05) was significantly associated with acute rejection (AR), whereas CDC (OR = 2.09; 95% CI, 0.55‐7.99; P = 0.28) and FCXM positivity (OR = 2.07; 95% CI, 0.73‐5.87; P = 0.17) were not. Similarly, DSA MFI ≥ 5000 (OR = 4.14; P = 0.02) was the only significant factor affecting the risk of AMR. Conclusions: Of the various XM tests, DSA MFI ≥5000 was the most prominent predictor of AR in patients undergoing HLA‐i KT.