Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies

Kwaku Marfo, Maria Ajaimy, Adriana Colovai, Liise Kayler, Stuart M. Greenstein, Michelle Lubetzky, Anjali Gupta, Layla Kamal, Graciela De Boccardo, Peter Masiakos, Milan Kinkhabwala, Enver Akalin

Research output: Contribution to journalArticle

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Abstract

Background: Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. Methods: Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. Results: Patients had a mean number of 1.6±0.8 DSAs with a mean fluorescence intensity value of 2,815±2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129±49 and 159±52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA-groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA-group were similar. Two DSA+ (3%) and five DSA-(2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4±0.6 mg/dL). Conclusion: Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSAj patients with pretransplantation immunologic risk assessment.

Original languageEnglish (US)
Pages (from-to)1082-1088
Number of pages7
JournalTransplantation
Volume98
Issue number10
DOIs
StatePublished - Jan 1 2014

Fingerprint

HLA Antigens
Tissue Donors
Kidney
Antibodies
Graft Survival
Flow Cytometry
B-Lymphocytes
Fluorescence
T-Lymphocytes
Transplant Recipients
Antilymphocyte Serum
Intravenous Immunoglobulins
Kidney Transplantation
Creatinine
Cohort Studies
Prospective Studies
Transplants
Safety
Antigens
Serum

Keywords

  • Acute rejection
  • Donor-specific antibody
  • Intravenous immunoglobulin
  • Renal transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies. / Marfo, Kwaku; Ajaimy, Maria; Colovai, Adriana; Kayler, Liise; Greenstein, Stuart M.; Lubetzky, Michelle; Gupta, Anjali; Kamal, Layla; De Boccardo, Graciela; Masiakos, Peter; Kinkhabwala, Milan; Akalin, Enver.

In: Transplantation, Vol. 98, No. 10, 01.01.2014, p. 1082-1088.

Research output: Contribution to journalArticle

Marfo, Kwaku ; Ajaimy, Maria ; Colovai, Adriana ; Kayler, Liise ; Greenstein, Stuart M. ; Lubetzky, Michelle ; Gupta, Anjali ; Kamal, Layla ; De Boccardo, Graciela ; Masiakos, Peter ; Kinkhabwala, Milan ; Akalin, Enver. / Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies. In: Transplantation. 2014 ; Vol. 98, No. 10. pp. 1082-1088.
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abstract = "Background: Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. Methods: Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. Results: Patients had a mean number of 1.6±0.8 DSAs with a mean fluorescence intensity value of 2,815±2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129±49 and 159±52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99{\%} vs. 95{\%}) and graft survival (88{\%} vs. 90{\%}) rates between DSA+ and DSA-groups, respectively. Cumulative acute rejection rates of 11{\%} in the DSA+ group and 12{\%} in the DSA-group were similar. Two DSA+ (3{\%}) and five DSA-(2{\%}) patients developed chronic antibody-mediated rejection (3{\%}). The mean serum creatinine levels were identical between the two groups (1.4±0.6 mg/dL). Conclusion: Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSAj patients with pretransplantation immunologic risk assessment.",
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AU - Marfo, Kwaku

AU - Ajaimy, Maria

AU - Colovai, Adriana

AU - Kayler, Liise

AU - Greenstein, Stuart M.

AU - Lubetzky, Michelle

AU - Gupta, Anjali

AU - Kamal, Layla

AU - De Boccardo, Graciela

AU - Masiakos, Peter

AU - Kinkhabwala, Milan

AU - Akalin, Enver

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N2 - Background: Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. Methods: Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. Results: Patients had a mean number of 1.6±0.8 DSAs with a mean fluorescence intensity value of 2,815±2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129±49 and 159±52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA-groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA-group were similar. Two DSA+ (3%) and five DSA-(2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4±0.6 mg/dL). Conclusion: Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSAj patients with pretransplantation immunologic risk assessment.

AB - Background: Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. Methods: Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. Results: Patients had a mean number of 1.6±0.8 DSAs with a mean fluorescence intensity value of 2,815±2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129±49 and 159±52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA-groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA-group were similar. Two DSA+ (3%) and five DSA-(2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4±0.6 mg/dL). Conclusion: Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSAj patients with pretransplantation immunologic risk assessment.

KW - Acute rejection

KW - Donor-specific antibody

KW - Intravenous immunoglobulin

KW - Renal transplantation

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