Background

We investigated the impact of de novo donor-specific anti-human leukocyte antigen antibodies (dnDSAs) on long-term death-censored graft survival and renal allograft rejection in kidney transplant recipients.

Methods

The sample for this retrospective cohort study comprised 121 recipients of kidney transplants with negative complement-dependent cytotoxicity crossmatches to their deceased donors. Recipients were divided into two groups: dnDSAs+ (n = 31) and dnDSAs- (n = 90). We evaluated rejection and long-term graft survival rates in the recipients along with pathologic changes in the transplanted kidneys.

Results

DnDSAs were identified in 31/121 patients (25.6%). The graft survival rate in the dnDSAs+ group was 87.1% (27/31) and that of the dnDSAs- group was 97.8% (88/90). The dnDSAs+ group had lower graft survival rates than patients without dnDSAs (p = 0.007). There was no difference in the graft survival rates between patients with high DSA mean fluorescence intensity (≥4000) and those with low intensity (<4000) (p = 0.669). There was also no difference in the graft survival rates of patients with HLA class I, II, and I + II dnDSAs (p = 0.571). The presence of dnDSA in serum was associated with a higher incidence of antibody- and T-cell–mediated rejection (p < 0.0001). Banff scores for arterial fibrointimal and arteriolar hyalin, thickening as well as C4d deposition differed for the dnDSAs+ and dnDSAs- groups (p < 0.05).

Conclusion

DnDSAs were found to be associated with decreased long-term graft survival rates and increased rejection rates, often accompanied by C4d deposition.

中文翻译：

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从头供体特异性 HLA 抗体降低移植物存活率并增加肾移植排斥反应的风险：一项单中心回顾性研究

背景

我们研究了从头供体特异性抗人白细胞抗原抗体 (dnDSA) 对肾移植受者的长期死亡审查移植物存活和同种异体移植肾排斥的影响。

方法

这项回顾性队列研究的样本包括 121 名肾移植受者，其与已故供体的补体依赖性细胞毒性交叉配型为阴性。接受者分为两组：dnDSAs+（n  = 31）和 dnDSAs-（n  = 90）。我们评估了受者的排斥和长期移植物存活率以及移植肾脏的病理变化。

结果

在 31/121 名患者 (25.6%) 中发现了 DnDSA。dnDSAs+组移植物存活率为87.1%（27/31），dnDSAs-组为97.8%（88/90）。dnDSAs+ 组的移植物存活率低于没有 dnDSAs 的患者 ( p  = 0.007)。高 DSA 平均荧光强度（≥4000）和低强度（<4000）患者的移植物存活率没有差异（p  = 0.669）。HLA I、II 和 I + II dnDSA 患者的移植物存活率也没有差异（p  = 0.571）。血清中 dnDSA 的存在与抗体和 T 细胞介导的排斥反应的发生率较高有关（p < 0.0001)。dnDSAs+ 和 dnDSAs- 组的动脉纤维内膜和小动脉透明蛋白、增厚以及 C4d 沉积的 Banff 评分不同（p  < 0.05）。

结论

发现 DnDSA 与长期移植物存活率降低和排斥率增加有关，通常伴有 C4d 沉积。