Pretransplant C3D-fixing donor-specific anti-HLA antibodies are not associated with increased risk for kidney graft failure
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Publication date
2018-09-01
Authors
Kamburova, E. G.
Wisse, Bram W.
Joosten, Irma
Allebes, Wil A.
Van Der Meer, Arnold
Hilbrands, Luuk B.
Baas, Marije C.
Spierings, Eric
Hack, Erik
van Reekum, Franka E
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Article
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taverne
Abstract
Background Complement-fixing antibodies against donor HLA are considered a contraindication for kidney transplant. A modification of the IgG single-antigen bead (SAB) assay allows detection of anti-HLA antibodies that bind C3d. Because early humoral graft rejection is considered to be complement mediated, this SAB-based technique may provide a valuable tool in the pretransplant risk stratification of kidney transplant recipients. Methods Previously, we established that pretransplant donor-specific anti-HLA antibodies (DSAs) are associated with increased risk for long-term graft failure in complement-dependent cytotoxicity crossmatch-negative transplants. In this study, we further characterized the DSA-positive serum samples using the C3d SAB assay. Results Among 567 pretransplant DSA-positive serum samples, 97 (17%) contained at least one C3d-fixing DSA, whereas 470 (83%) had non-C3d-fixing DSA. At 10 years after transplant, patients with C3d-fixing antibodies had a death-censored, covariate-adjusted graft survival of 60%, whereas patients with non-C3d-fixing DSA had a graft survival of 64% (hazard ratio, 1.02; 95% confidence interval, 0.70 to 1.48 for C3d-fixing DSA compared with non-C3d-fixing DSA; P50.93). Patients without DSA had a 10-year graft survival of 78%. Conclusions The C3d-fixing ability of pretransplant DSA is not associated with increased risk for graft failure.
Keywords
Taverne, Nephrology
Citation
Kamburova, E G, Wisse, B W, Joosten, I, Allebes, W A, Van Der Meer, A, Hilbrands, L B, Baas, M C, Spierings, E, Hack, C E, Van Reekum, F E, Van Zuilen, A D, Verhaar, M C, Bots, M L, Drop, A C A D, Plaisier, L, Seelen, M A J, Sanders, J S, Hepkema, B G, Lambeck, A J A, Bungener, L B, Roozendaal, C, Tilanus, M G J, Voorter, C E, Wieten, L, Van Duijnhoven, E M, Gelens, M A C J, Christiaans, M H L, Van Ittersum, F J, Nurmohamed, S A, Lardy, N M, Swelsen, W, Van Der Pant, K A M I, Van Der Weerd, N C, Ten Berge, I J M, Bemelman, F J, Hoitsma, A J, Van Der Boog, P J M, De Fijter, J W, Betjes, M G H, Heidt, S, Roelen, D L, Claas, F H & Otten, H G 2018, 'Pretransplant C3D-fixing donor-specific anti-HLA antibodies are not associated with increased risk for kidney graft failure', Journal of the American Society of Nephrology, vol. 29, no. 9, pp. 2279-2285. https://doi.org/10.1681/ASN.2018020205