Missing Self-Induced Activation of NK Cells Combines with Non-Complement-Fixing Donor-Specific Antibodies to Accelerate Kidney Transplant Loss in Chronic Antibody-Mediated Rejection.
J Am Soc Nephrol
; 32(2): 479-494, 2021 02.
Article
in English
| MEDLINE | ID: covidwho-1496663
ABSTRACT
BACKGROUND:
Binding of donor-specific antibodies (DSAs) to kidney allograft endothelial cells that does not activate the classic complement cascade can trigger the recruitment of innate immune effectors, including NK cells. Activated NK cells contribute to microvascular inflammation leading to chronic antibody-mediated rejection (AMR). Recipient NK cells can also trigger antibody-independent microvascular inflammation by sensing the absence of self HLA class I molecules ("missing self") on allograft endothelial cells. This translational study investigated whether the condition of missing self amplifies DSA-dependent NK cell activation to worsen chronic AMR. METHODS ANDRESULTS:
Among 1682 kidney transplant recipients who underwent an allograft biopsy at Lyon University Hospital between 2004 and 2017, 135 fulfilled the diagnostic criteria for AMR and were enrolled in the study. Patients with complement-fixing DSAs identified by a positive C3d binding assay (n=73, 54%) had a higher risk of transplant failure (P=0.002). Among the remaining patients with complement-independent chronic AMR (n=62, 46%), those in whom missing self was identified through donor and recipient genotyping exhibited worse allograft survival (P=0.02). In multivariable analysis, only proteinuria (HR 7.24; P=0.01) and the presence of missing self (HR 3.57; P=0.04) were independent predictors for transplant failure following diagnosis of chronic AMR. Cocultures of human NK cells and endothelial cells confirmed that addition of missing self to DSA-induced NK cell activation increased endothelial damage.CONCLUSIONS:
The assessment of missing self at the time of diagnosis of chronic AMR identifies patients at higher risk for kidney transplant failure.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Killer Cells, Natural
/
Histocompatibility Antigens Class I
/
Kidney Transplantation
/
Complement Activation
/
Allografts
/
Graft Rejection
Type of study:
Prognostic study
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
/
Young adult
Language:
English
Journal:
J Am Soc Nephrol
Journal subject:
Nephrology
Year:
2021
Document Type:
Article
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