The impact of pretransplant donor-specific antibodies on graft outcome in renal transplantation: a six-year follow-up study
Clinics
;
67(4): 355-361, 2012. ilus, tab
Article
in English
| LILACS
| ID: lil-623115
ABSTRACT
OBJECTIVE:
The significance of pretransplant, donor-specific antibodies on long-term patient outcomes is a subject of debate. This study evaluated the impact and the presence or absence of donor-specific antibodies after kidney transplantation on short- and long-term graft outcomes.METHODS:
We analyzed the frequency and dynamics of pretransplant donor-specific antibodies following renal transplantation from a randomized trial that was conducted from 2002 to 2004 and correlated these findings with patient outcomes through 2009. Transplants were performed against a complement-dependent T- and B-negative crossmatch. Pre- and posttransplant sera were available from 94 of the 118 patients (80%). Antibodies were detected using a solid-phase (LuminexH), single-bead assay, and all tests were performed simultaneously.RESULTS:
Sixteen patients exhibited pretransplant donor-specific antibodies, but only 3 of these patients (19%) developed antibody-mediated rejection and 2 of them experienced early graft losses. Excluding these 2 losses, 6 of 14 patients exhibited donor-specific antibodies at the final follow-up exam, whereas 8 of these patients (57%) exhibited complete clearance of the donor-specific antibodies. Five other patients developed ''de novo'' posttransplant donor-specific antibodies. Death-censored graft survival was similar in patients with pretransplant donor-specific and non-donor-specific antibodies after a mean follow-up period of 70 months.CONCLUSION:
Pretransplant donor-specific antibodies with a negative complement-dependent cytotoxicity crossmatch are associated with a risk for the development of antibody-mediated rejection, although survival rates are similar when patients transpose the first months after receiving the graft. Our data also suggest that early posttransplant donor-specific antibody monitoring should increase knowledge of antibody dynamics and their impact on long-term graft outcome.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Tissue Donors
/
Blood Grouping and Crossmatching
/
Kidney Transplantation
/
Graft Rejection
/
Graft Survival
/
Antibodies
Type of study:
Controlled clinical trial
/
Observational study
/
Prevalence study
/
Prognostic study
/
Risk factors
Limits:
Adolescent
/
Adult
/
Female
/
Humans
Language:
English
Journal:
Clinics
Journal subject:
Medicine
Year:
2012
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Universidade de São Paulo/BR
Similar
MEDLINE
...
LILACS
LIS