Donor‐specific antibodies detected by single antigen beads alone can help risk stratify patients undergoing retransplantation across a repeat HLA mismatch. Issue 2 (16th October 2019)

• Record Type: Journal Article
• Authors: Lucisano, Gaetano; Thiruvengadam, Srivathsan; Hassan, Sevda; Gueret‐Wardle, Alexander; Brookes, Paul; Santos‐Nunez, Eva; Willicombe, Michelle
• Is Part Of: American journal of transplantation. Volume 20:Issue 2(2020)
• Page Start: 441
• Page End: 450
• Publication Date: 2019-10-16
• Subjects: clinical research/practice -- graft survival -- histocompatibility -- kidney transplantation/nephrology -- rejection -- retransplantation -- risk assessment/risk stratification -- sensitization; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15595
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Whether reexposure to mismatched HLA antigens (RMM) in the setting of a negative crossmatch is associated with increased immunological risk remains an area of uncertainty. This is due to evidence derived predominantly from registry data, which lacks comprehensive information on alloantibody and rejection. In this study, we analyze the impact of low‐level preformed donor‐specific antibodies (DSA) against an RMM on transplant outcomes. From 1988 consecutive renal transplant recipients, we analyzed 179 patients undergoing retransplantation, of whom 55 had a RMM. All patients were crossmatch negative and preformed DSA were detected by single antigen beads alone. Multivariate analysis revealed that patients with preformed DSA against an RMM were independently at risk of antibody‐mediated rejection (HR 8.70 [3.42‐22.10], P < .0001) and death‐censored allograft loss (HR 3.08 [1.17‐8.14], P = .023). In addition, prior transplant nephrectomy (HR 2.04 [1.00‐4.17], P = .0495) was also associated with allograft failure, whereas receiving a retransplant that was matched at HLA class II was associated with a favorable outcome (HR 0.37 [0.14‐0.99], P = .047). In the absence of preformed DSA, an RMM was not associated with de novo DSA development, rejection, or allograft loss. In conclusion, an RMM portends increased immunological risk only in the presence of a preformed DSA in patients undergoing retransplantation. Abstract : In this study, the authors focus on immunological risk stratification through the use of single antigen bead testing and allograft outcome analysis in patients undergoing kidney retransplantation across a repeat HLA mismatch.