Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

E G Kamburova*, B W Wisse, I Joosten, WA Allebes, A Meer, LB Hilbrands, M C Baas, E Spierings, CE Hack, F E van Reekum, AD van Zuilen, MC Verhaar, ML Bots, A Drop, L Plaisier, MAJ Seelen, JSF Sanders, BG Hepkema, AJA Lambeck, LB BungenerC Roozendaal, MGJ Tilanus, CE Voorter, L Wieten, E M van Duijnhoven, M Gelens, MHL Christiaans, FJ van Ittersum, SA Nurmohamed, NM Lardy, W Swelsen, K A van der Pant, NC van der Weerd, IJM ten Berge, FJ Bemelman, A Hoitsma, P J M van der Boog, JW de Fijter, M.G.H. Betjes, S Heidt, DL Roelen, FH Claas, HG Otten

*Corresponding author for this work

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The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.
Original languageUndefined/Unknown
Pages (from-to)2274-2284
Number of pages11
JournalAmerican Journal of Transplantation
Issue number9
Publication statusPublished - Sept 2018

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