Influence of a low-dose tacrolimus protocol on the appearance of de novo donor-specific antibodies during 7 years of follow-up after renal transplantation. Issue 6 (5th December 2020)

• Record Type: Journal Article
• Authors: Unagami, Kohei; Ishida, Hideki; Furusawa, Miyuki; Kitajima, Kumiko; Hirai, Toshihito; Kakuta, Yoichi; Toki, Daisuke; Shimizu, Tomokazu; Omoto, Kazuya; Okumi, Masayoshi; Nitta, Kosaku; Tanabe, Kazunari
• Is Part Of: Nephrology dialysis transplantation. Volume 36:Issue 6(2021)
• Page Start: 1120
• Page End: 1129
• Publication Date: 2020-12-05
• Subjects: clinical research/practice -- de novo donor-specific anti-HLA antibodies -- kidney transplantation/nephrology -- rejection -- tacrolimus; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfaa258
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background: Tacrolimus (TAC) is a key immunosuppressant drug for kidney transplantation (KTx). However, the optimal serum trough level of TAC for good long-term outcomes remains unclear. This study aimed to investigate the relationship between the maintenance TAC trough level and the appearance of de novo donor-specific anti-human leukocyte antigen (HLA) antibodies ( dn DSAs). Methods: A total of 584 KTx recipients were enrolled in this study, of whom 164 developed dn DSAs during the follow-up period and 420 did not. Results: We found no significant relationship between TAC trough level during the follow-up period and dn DSA incidence. Patients who developed dn DSAs had a significantly greater number of HLA-A/B/DR mismatches (3.4 ± 1.3 versus 2.8 ± 1.5; P < 0.001), were more likely to have preformed DSAs (48.2% versus 27.1%; P < 0.001) and showed poor allograft outcome. Conclusions: There was no clear relationship between TAC trough level and dn DSA incidence for KTx recipients whose TAC trough levels were kept within the narrow range of 4–6 ng/mL during the immunosuppression maintenance period.