Female recipients of a spousal donor kidney transplant are at greater risk of donor-specific pre-immunization, which may increase the risk of acute antibody-mediated rejection (ABMR). We assessed the incidence of early ABMR (within two weeks after transplantation), risk factors for ABMR and graft function in 352 complement-dependent cytotoxicity test-negative LURD transplant recipients, transplanted between 1997 and 2014 at the Leiden University Medical Center in The Netherlands. Risk factors for immunization were retrieved from the health records. As methods to screen for preformed donor-specific antibodies (pDSA) have developed through time, we retrospectively screened those with ABMR for pDSA using pooled-antigen bead (PAB) and single-antigen bead (SAB) assays. The cumulative incidence of rejection in the first six months after transplantation was 18% (TCMR 15%; early ABMR 3%). Early ABMR resulted in inferior graft survival and was more common in women who received a kidney from their spouse (10%) than in other women (2%) and men (<1%). The SAB assay retrospectively identified pDSA in seven of nine cases of early ABMR (78%), while the PAB detected pDSA in only three cases (33%). Seeing that early ABMR occurred in 10% of women who received a kidney from their spouse, a SAB assay should be included in the pre-transplant assessment of this group of women, regardless of the result of the PAB assay.

配偶供体肾移植的女性受者有更大的供体特异性预免疫风险，这可能会增加急性抗体介导排斥 (ABMR) 的风险。我们评估了 1997 年至 2014 年在荷兰莱顿大学医学中心移植的 352 名补体依赖性细胞毒性试验阴性 LURD 移植受者的早期 ABMR 的发生率（移植后两周内）、ABMR 的危险因素和移植物功能。从健康记录中检索免疫风险因素。随着时间的推移，筛选预先形成的供体特异性抗体 (pDSA) 的方法已经发展起来，我们使用混合抗原珠 (PAB) 和单抗原珠 (SAB) 测定法回顾性地筛选了 ABMR 患者的 pDSA。移植后前六个月排斥的累积发生率为 18%（TCMR 15%；早期 ABMR 3%）。早期 ABMR 导致移植物存活率较差，并且在从配偶那里接受肾脏的女性 (10%) 中比其他女性 (2%) 和男性 (<1%) 更常见。SAB 检测在 9 例早期 ABMR 病例中的 7 例（78%）中回顾性鉴定了 pDSA，而 PAB 仅在 3 例（33%）中检测到 pDSA。鉴于从配偶那里接受肾脏的女性中有 10% 发生了早期 ABMR，因此无论 PAB 检测的结果如何，这组女性的移植前评估都应包括 SAB 检测。SAB 检测在 9 例早期 ABMR 病例中的 7 例（78%）中回顾性鉴定了 pDSA，而 PAB 仅在 3 例（33%）中检测到 pDSA。鉴于从配偶那里接受肾脏的女性中有 10% 发生了早期 ABMR，因此无论 PAB 检测的结果如何，这组女性的移植前评估都应包括 SAB 检测。SAB 检测在 9 例早期 ABMR 病例中的 7 例（78%）中回顾性鉴定了 pDSA，而 PAB 仅在 3 例（33%）中检测到 pDSA。鉴于从配偶那里接受肾脏的女性中有 10% 发生了早期 ABMR，因此无论 PAB 检测的结果如何，这组女性的移植前评估都应包括 SAB 检测。