De novo donor-specific antibodies (dnDSA) play an important role in antibody-mediated rejection (ABMR) and graft failure, yet their development in kidney transplant recipients (KTx) of higher immunological risk has not been characterized. We prospectively determined the incidence of dnDSA at 3 and 12 months posttransplant and assessed their associations with outcomes in recipients stratified by low, moderate, and high immunological risk. Adult KTx were screened for DSA pretransplant, months 3 and 12 posttransplant, and when clinically indicated. Outcomes included incidence of dnDSA, death-censored graft survival (DCGS), and ABMR. Of 371 recipients, 154 (42%) were transplanted across a pretransplant DSA that became undetectable by 12 months posttransplant in 78% of cases. dnDSA were detected in 16% (95% confidence interval [CI]: 12-20%) by 3 months and 23% (95% CI: 18-29%) by 12 months posttransplant. Incidence at 12 months was higher in the moderate (30%) and high-risk groups (29%) compared to the low-risk group (16%). dnDSA were associated with an increased risk of ABMR (hazard ratio [HR] 2.2; 95% CI: 1.1-4.4; P = .04) but were not an independent risk factor for DCGS. In conclusion, dnDSA were more frequent in transplant recipients of higher immune risk and associated with an increased risk of ABMR.

中文翻译：

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低、中、高免疫风险肾移植受者的新供体特异性抗体的开发和结果。

从头供体特异性抗体 (dnDSA) 在抗体介导的排斥反应 (ABMR) 和移植物失败中发挥重要作用，但它们在具有较高免疫风险的肾移植受者 (KTx) 中的发展尚未得到表征。我们前瞻性地确定了移植后 3 个月和 12 个月时 dnDSA 的发生率，并评估了它们与按低、中和高免疫风险分层的受者结果的关联。成人 KTx 在移植前、移植后第 3 个月和第 12 个月以及有临床指征时进行 DSA 筛查。结果包括 dnDSA 的发生率、死亡审查的移植物存活率 (DCGS) 和 ABMR。在 371 名接受者中，154 名 (42%) 通过移植前 DSA 进行了移植，78% 的病例在移植后 12 个月时检测不到。dnDSA 在 16%（95% 置信区间 [CI]：移植后 3 个月为 12-20%），移植后 12 个月为 23%（95% CI：18-29%）。与低风险组 (16%) 相比，中等风险组 (30%) 和高风险组 (29%) 的 12 个月发病率更高。dnDSA 与 ABMR 风险增加相关（风险比 [HR] 2.2；95% CI：1.1-4.4；P = .04），但不是 DCGS 的独立危险因素。总之，dnDSA 在免疫风险较高的移植受者中更为常见，并且与 ABMR 风险增加相关。