Pre‐transplant donor‐specific HLA antibodies and risk for poor first‐year renal transplant outcomes: results from the Swiss Transplant Cohort Study. (13th October 2021)

• Record Type: Journal Article
• Authors: Wehmeier, Caroline; Amico, Patrizia; Sidler, Daniel; Wirthmüller, Urs; Hadaya, Karine; Ferrari‐Lacraz, Sylvie; Golshayan, Déla; Aubert, Vincent; Schnyder, Aurelia; Sunic, Kata; Schachtner, Thomas; Nilsson, Jakob; Schaub, Stefan
• Other Names: Axel Andres investigator.; Aubert John‐David investigator.; Banz Vanessa investigator.; Sonja Beckmann investigator.; Beldi Guido investigator.; Berger Christoph investigator.; Berishvili Ekaterine investigator.; Binet Isabelle investigator.; Bochud Pierre‐Yves investigator.; Branca Sanda investigator.; Bucher Heiner investigator.; Carrel Thierry investigator.; Catana Emmanuelle investigator.; Chalandon Yves investigator.; De Geest Sabina investigator.; De Rougemont Olivier investigator.; Dickenmann Michael investigator.; Dreifuss Joëlle Lynn investigator.; Duchosal Michel investigator.; Fehr Thomas investigator.; Franscini Nicola investigator.; Garzoni Christian investigator.; Soccal Paola Gasche investigator.; Gaudet Christophe investigator.; Goossens Nicolas investigator.; Halter Jörg investigator.; Heim Dominik investigator.; Hess Christoph investigator.; Hillinger Sven investigator.; Hirsch Hans investigator.; Hirt Patricia investigator.; Hofbauer Günther investigator.; Huynh‐Do Uyen investigator.; Immer Franz investigator.; Koller Michael investigator.; Laager Mirjam investigator.; Laesser Bettina investigator.; Lehmann Roger investigator.; Leichtle Alexander investigator.; Lovis Christian investigator.; Manuel Oriol investigator.; Marti Hans‐Peter investigator.; Martin Pierre Yves investigator.; Martinelli Michele investigator.; McLin Valérie investigator.; Mellac Katell investigator.; Merçay Aurélia investigator.; Mettler Karin investigator.; Mueller Nicolas investigator.; Müller Antonia investigator.; Müller Thomas investigator.; Müller‐Arndt Ulrike investigator.; Müllhaupt Beat investigator.; Nägeli Mirjam investigator.; Oldani Graziano investigator.; Pascual Manuel investigator.; Posfay‐Barbe Klara investigator.; Rick Juliane investigator.; Rosselet Anne investigator.; Rossi Simona investigator.; Rothlin Silvia investigator.; Ruschitzka Frank investigator.; Schanz Urs investigator.; Schuurmans Macé investigator.; Sengstag Thierry investigator.; Simonetta Federico investigator.; Staufer Katharina investigator.; Stampf Susanne investigator.; Steiger Jürg investigator.; Stirniman Guido investigator.; Stürzinger Ueli investigator.; Van Delden Christian investigator.; Venetz Jean‐Pierre investigator.; Villard Jean investigator.; Vionnet Julien investigator.; Wick Madeleine investigator.; Wilhlem Markus investigator.; Yerly Patrick investigator.;
• Is Part Of: Transplant international. Volume 34:Number 12(2021)
• Page Start: 2755
• Page End: 2768
• Publication Date: 2021-10-13
• Subjects: allograft failure -- allograft loss -- donor‐specific HLA antibodies -- DSA -- rejection -- renal transplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.14119
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: The aim of this study was to analyze first year renal outcomes in a nationwide prospective multicenter cohort comprising 2215 renal transplants, with a special emphasis on the presence of pre‐transplant donor‐specific HLA antibodies (DSA). All transplants had a complete virtual crossmatch and DSA were detected in 19% (411/2215). The investigated composite endpoint was a poor first‐year outcome defined as (i) allograft failure or (ii) death or (iii) poor allograft function (eGFR ≤25 ml/min/1.73 m 2 ) at one year. Two hundred and twenty‐one (221/2215; 10%) transplants showed a poor first‐year outcome. Rejection (24/70; 34%) was the most common reason for graft failure. First‐year patient's death was rare (48/2215; 2%). There were no statistically significant differences between DSA‐positive and DSA‐negative transplants regarding composite and each individual endpoint, as well as reasons for graft failure and death. DSA‐positive transplants experienced more frequently rejection episodes, mainly antibody‐mediated rejection (both P < 0.0001). The combination of DSA and any first year rejection was associated with the overall poorest death‐censored allograft survival ( P < 0.0001). In conclusion, presence of pre‐transplant DSA per se does not affect first year outcomes. However, DSA‐positive transplants experiencing first year rejection are a high‐risk population for poor allograft survival and may benefit from intense clinical surveillance. Abstract : In this nationwide prospective multicenter cohort, 10% of transplants showed a poor first‐year outcome. Presence of pre‐transplant DSA per se did not affect first year outcomes. However, occurrence of first year rejection in DSA‐positive transplants was, in contrast to those without rejection, associated with a poor allograft survival.