Abstract:

BACKGROUND: Sensitive techniques are able to detect low levels of circulating antibodies. However, clinical consequences of these antibodies still unknown.
OBJECTIVE: To investigate the clinical significance of donor-specific anti-HLA antibodies (DSA) for sensitized renal transplantation recipients and it role in predicting early rejection after kidney transplantation.
METHODS: Patients who received kidney transplantation were tested for pre-transplant complement-dependent cytotoxicity (CDC) crossmatches and panel reactive antibodies (PRA). Patients were considered to have circulating antibodies if PRA was equal to or greater than 10%. These patients were then analyzed for DSA. Clinical outcomes were compared in patients with and without DSAs.
RESULTS AND CONCLUSION: In a total of 379 patients who underwent transplantation, 55 had PRA equal to or greater than 10%. Of these 55 patients, 75% had a history of a sensitizing event. Twenty out of 55 patients were DSA+. Patients with DSA detected by ELISA had higher rates of delayed graft function, acute rejection, and lower rates of graft survival. The detection of DSA was associated with significantly higher rates of graft dysfunction and immunological events. Conversely, the presence of antibodies but no DSA was associated with excellent outcomes. In patients with negative CDC crossmatches, the occurrence of low-level DSA could assist in identifying patients that require more aggressive immune monitoring or immunosuppressive strategies.