Prospective de novo DSA monitoring in renal transplant patients
Asimina Fylaktou1, Erasmia Sampani2, Efstratios Kasimatis2, Marianthi Papachristou1, Chrysostomos Dimitriadis2, Aikaterini Anastasiou1, Eleni Chatzidrosou1, Konstantia Xerra1, Maria Daoudaki3, Ioannis Fouzas3, Aikaterini Papagianni2.
1National Peripheral Histocompatibility Center, Immunology Department, Hippokration General Hospital, Thessaloniki, Greece; 2Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece; 3Division of Organ Transplantation, Department of Surgery, Aristotle University Medical School, Hippokration General Hospital, Thessaloniki, Greece
Introduction: De novo Donor Specific Antibodies (dnDSA) are associated with antibody-mediated rejection leading to renal transplant failure. However, many transplant patients are stable with no signs of graft dysfunction at the time of dnDSA detection in a routine test.
Materials and Methods: In a routine test including 110 renal transplant patients, at least 6 months after transplantation, dnDSA were detected, using Single Antigen Bead Luminex assay, in 26 (15 males) of them. We prospectively studied these dnDSA positive patients for 3 years. Proteinuria and eGFR were evaluated along with dnDSA monitoring, at least annually.
Results and Discussion: Graft loss associated with dnDSA occurred in 8 (31%) patients, 14±11 months after the initial detection of dnDSA. These patients had more frequently multiple dnDSA (p=0.004) and remarkable proteinuria, more than 1g daily (p<0.001). The remaining 18 patients were followed for 38±15 months and considered stable as there was no deterioration regarding eGFR and proteinuria. In 7(39%) of these patients dnDSA waned and were not detected anymore at follow up. Antibodies against HLA class II had a significant (p<0.001) greater Mean Fluorescence Intensity (MFI) (11109±6414) compared to those against HLA class I (2603±1098) and in regression analysis they were predictive of dnDSA insistence (p=0.043, OR: 0.18, 95%CI: 0.04-0.94). Despite fluctuations during follow up there was no significant change in MFI for those who retained the dnDSA.
Conclusion: The presence of dnDSA is transient in a considerable proportion of stable renal transplant patients, especially in those with antibodies against HLA class I and a low MFI. Multiple dnDSA and significant proteinuria are correlated with an adverse prognosis for graft survival.
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