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Impact of pretransplant donor-specific antibodies on kidney allograft recipients with negative flow cytometry cross-matches.
Clin Transplant. 2018 06; 32(6):e13266.CT

Abstract

The Luminex test can detect low levels of donor-specific antibody (DSA) that cannot be detected by flow-cytometric cross-matching (FCXM) in kidney transplantation (KT). This study evaluated the impact of DSA on clinical outcomes in KT recipients negative on FCXM. Of 575 consecutive patients who underwent living donor KT between January 2013 and July 2016, 494 (85.9%) were DSA-negative and 81 (14.1%) were DSA-positive. Although rates of acute cellular rejection (ACR) at 1 year were similar in the 2 groups (P = .54), the incidence of antibody-mediated rejection (ABMR) was significantly higher in the DSA-positive group (P < .01). There was no statistically significant association between rejection-free graft survival (RFGS) rates and pretransplant class I DSA. However, evaluation of pretransplant class II DSA showed that RFGS rates were significantly lower in patients with mean fluorescence intensity (MFI) >3000 than in patients with DSA-negative (P < .01). On multivariate analyses, class II DSA MFI ≥5000 was a significant risk factor for acute rejection (hazard ratio, 7.48; P < .01). These findings suggested that pretransplant DSA alone did not affect graft survival in KT recipients without desensitization. However, class II DSA MFI >5000 was an independent predictor of acute rejection in DSA-positive patients.

Authors+Show Affiliations

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29676812

Citation

Kwon, Hyunwook, et al. "Impact of Pretransplant Donor-specific Antibodies On Kidney Allograft Recipients With Negative Flow Cytometry Cross-matches." Clinical Transplantation, vol. 32, no. 6, 2018, pp. e13266.
Kwon H, Kim YH, Choi JY, et al. Impact of pretransplant donor-specific antibodies on kidney allograft recipients with negative flow cytometry cross-matches. Clin Transplant. 2018;32(6):e13266.
Kwon, H., Kim, Y. H., Choi, J. Y., Shin, S., Jung, J. H., Park, S. K., & Han, D. J. (2018). Impact of pretransplant donor-specific antibodies on kidney allograft recipients with negative flow cytometry cross-matches. Clinical Transplantation, 32(6), e13266. https://doi.org/10.1111/ctr.13266
Kwon H, et al. Impact of Pretransplant Donor-specific Antibodies On Kidney Allograft Recipients With Negative Flow Cytometry Cross-matches. Clin Transplant. 2018;32(6):e13266. PubMed PMID: 29676812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of pretransplant donor-specific antibodies on kidney allograft recipients with negative flow cytometry cross-matches. AU - Kwon,Hyunwook, AU - Kim,Young Hoon, AU - Choi,Ji Yoon, AU - Shin,Sung, AU - Jung,Joo Hee, AU - Park,Su-Kil, AU - Han,Duck Jong, Y1 - 2018/06/03/ PY - 2018/04/12/accepted PY - 2018/4/21/pubmed PY - 2019/10/24/medline PY - 2018/4/21/entrez KW - alloantibody KW - graft rejection KW - kidney transplantation SP - e13266 EP - e13266 JF - Clinical transplantation JO - Clin Transplant VL - 32 IS - 6 N2 - The Luminex test can detect low levels of donor-specific antibody (DSA) that cannot be detected by flow-cytometric cross-matching (FCXM) in kidney transplantation (KT). This study evaluated the impact of DSA on clinical outcomes in KT recipients negative on FCXM. Of 575 consecutive patients who underwent living donor KT between January 2013 and July 2016, 494 (85.9%) were DSA-negative and 81 (14.1%) were DSA-positive. Although rates of acute cellular rejection (ACR) at 1 year were similar in the 2 groups (P = .54), the incidence of antibody-mediated rejection (ABMR) was significantly higher in the DSA-positive group (P < .01). There was no statistically significant association between rejection-free graft survival (RFGS) rates and pretransplant class I DSA. However, evaluation of pretransplant class II DSA showed that RFGS rates were significantly lower in patients with mean fluorescence intensity (MFI) >3000 than in patients with DSA-negative (P < .01). On multivariate analyses, class II DSA MFI ≥5000 was a significant risk factor for acute rejection (hazard ratio, 7.48; P < .01). These findings suggested that pretransplant DSA alone did not affect graft survival in KT recipients without desensitization. However, class II DSA MFI >5000 was an independent predictor of acute rejection in DSA-positive patients. SN - 1399-0012 UR - https://www.unboundmedicine.com/medline/citation/29676812/Impact_of_pretransplant_donor_specific_antibodies_on_kidney_allograft_recipients_with_negative_flow_cytometry_cross_matches_ L2 - https://doi.org/10.1111/ctr.13266 DB - PRIME DP - Unbound Medicine ER -