Pretransplant donor-specific antibodies detected by single-antigen bead flow cytometry are associated with inferior kidney transplant outcomes

Neeraj Singh, Arjang Djamali, David Lorentzen, John D. Pirsch, Glen Leverson, Nikole Neidlinger, Barbara Voss, Jose R. Torrealba, R. Michael Hofmann, Jon Odorico, Luis A. Fernandez, Hans W. Sollinger, Milagros Samaniego

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

Background. The clinical significance of pretransplant donor-specific antibodies (pre-Tx DSAs) detected by single-antigen bead flow cytometry (SAB-FC) remains unclear. Methods. To investigate the impact that pre-Tx DSAs detected by SAB-FC have on early clinical outcomes, we tested pre-Tx sera from all consecutive deceased-donor kidney transplants performed between January 2005 and July 2006 (n=237). Results. In the study population of which 66% had ahigh-immunologic risk, mean fluorescence intensity (MFI) more than or equal to 100 for class I and more than or equal to 200 for class II were the lowest DSA thresholds associated with inferior antibody-mediated rejection-free graft survival (75% vs. 90%, P=0.004 and 76% vs. 87%, P=0.017, respectively). The hazard ratio for antibody-mediated rejection increased linearly with higher class II DSA from MFI 100 to 800 (1.7[0.8-3.2], P=0.1 for MFI≥100 vs. 4.7[2.4-8.8], P<0.001 for MFI ≥800). Differences in graft function were only evident in patients with class II MFI more than or equal to 500 (estimated glomerular filtration rate: 47.6 vs. 54.3, P=0.02 and proteinuria: 0.6±0.6 vs. 0.4±0.3, P=0.03). A difference in death-censored graft survival was detected in patients with class II MFI more than or equal to 1000 (75% vs. 91.9%, P=0.055). Conclusion. High-pre-Tx DSAs detected by SAB-FC are associated with incrementally poor graft outcomes in deceased-donor kidney transplant with high-immunologic risk.

Original languageEnglish (US)
Pages (from-to)1079-1084
Number of pages6
JournalTransplantation
Volume90
Issue number10
DOIs
StatePublished - Nov 27 2010

Keywords

  • Antibody-mediated rejection
  • High-immunologic risk
  • Single-antigen bead flow cytometry

ASJC Scopus subject areas

  • Transplantation

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    Singh, N., Djamali, A., Lorentzen, D., Pirsch, J. D., Leverson, G., Neidlinger, N., Voss, B., Torrealba, J. R., Hofmann, R. M., Odorico, J., Fernandez, L. A., Sollinger, H. W., & Samaniego, M. (2010). Pretransplant donor-specific antibodies detected by single-antigen bead flow cytometry are associated with inferior kidney transplant outcomes. Transplantation, 90(10), 1079-1084. https://doi.org/10.1097/TP.0b013e3181f6a07b