Preformed cytotoxic HLA donor-speci?c-antibodies (DSAs) rep-resent an absolute contraindication in kidney transplantation. Thenew Luminex-Single Antigen (LSA) beads assay allows detectionof HLA DSAs at low mean ?uorescence intensity (MFI) values.However, the clinical relevance of low-MFI DSAs is still matter ofdebate. We analysed graft outcome of 153 pre-sensitised patientswho had been transplanted between May 2007 and December2014 on the basis of both CDC-XM and FC-XM negative results.Seven patients were excluded from the study because of graft lossfor non-immunologic causes.Seventy-eight (53%) patients did nothave pre-formed HLA DSAs.The remaining 68 (47%) patientshad pre-transplant "acceptable" DSAs (MFI < 5000) speci?c forHLA-A/ -B/ -C/ -DR/ and -DQB molecules and/or anti-DPB/DQADSAs at high MFI values (>5000). Forty-three anti-HLA classI DSAs were present in 37 patients. Thirty anti-HLA class IIDSAs were present in 24 patients. The remaining 7 patientshad both HLA class I and class II DSAs.Analysing graft out-come of the two groups of patients, we did not observe anysigni?cant difference between acceptable-DSA positive patients(follow up = 35 ± 22 months) and DSA negative patients (followup = 34 ± 23 months) [Rejection: 9% vs 9%, P = 1.00; Graft Fail-ure: 7% vs 8%, P = 1.00]. In particular, among the DSA positivepatients, acute humoral rejection, without graft failure, occurredin 4 (6%) subjects; cellular rejection occurred in 2 (3%) patientsand one of these lost the graft. Five DSA positive patients sufferedgraft failure, which was never due to antibody-mediated rejectioncaused by pre-formed DSAs. Our data demonstrate that pre-formedDSAs with low MFI values are not associated with kidney graft fail-ure if pre-transplant CDC-XM and FC-XM give negative results.An accurate evaluation of the "strength" of LSA-detected DSAsallows transplantiion in patients with clinically "irrelevant" HLAantibodies and improves immunological risk strati?cation in kid-ney transplantation.
PREFORMED "ACCEPTABLE" DONOR SPECIFIC ANTIBODIES AND GRAFT OUTCOME IN KIDNEY TRANSPLANTATION
Poggi Elvira;Ozzella Giuseppina;
2016
Abstract
Preformed cytotoxic HLA donor-speci?c-antibodies (DSAs) rep-resent an absolute contraindication in kidney transplantation. Thenew Luminex-Single Antigen (LSA) beads assay allows detectionof HLA DSAs at low mean ?uorescence intensity (MFI) values.However, the clinical relevance of low-MFI DSAs is still matter ofdebate. We analysed graft outcome of 153 pre-sensitised patientswho had been transplanted between May 2007 and December2014 on the basis of both CDC-XM and FC-XM negative results.Seven patients were excluded from the study because of graft lossfor non-immunologic causes.Seventy-eight (53%) patients did nothave pre-formed HLA DSAs.The remaining 68 (47%) patientshad pre-transplant "acceptable" DSAs (MFI < 5000) speci?c forHLA-A/ -B/ -C/ -DR/ and -DQB molecules and/or anti-DPB/DQADSAs at high MFI values (>5000). Forty-three anti-HLA classI DSAs were present in 37 patients. Thirty anti-HLA class IIDSAs were present in 24 patients. The remaining 7 patientshad both HLA class I and class II DSAs.Analysing graft out-come of the two groups of patients, we did not observe anysigni?cant difference between acceptable-DSA positive patients(follow up = 35 ± 22 months) and DSA negative patients (followup = 34 ± 23 months) [Rejection: 9% vs 9%, P = 1.00; Graft Fail-ure: 7% vs 8%, P = 1.00]. In particular, among the DSA positivepatients, acute humoral rejection, without graft failure, occurredin 4 (6%) subjects; cellular rejection occurred in 2 (3%) patientsand one of these lost the graft. Five DSA positive patients sufferedgraft failure, which was never due to antibody-mediated rejectioncaused by pre-formed DSAs. Our data demonstrate that pre-formedDSAs with low MFI values are not associated with kidney graft fail-ure if pre-transplant CDC-XM and FC-XM give negative results.An accurate evaluation of the "strength" of LSA-detected DSAsallows transplantiion in patients with clinically "irrelevant" HLAantibodies and improves immunological risk strati?cation in kid-ney transplantation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
