PMID- 31440696
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220409
IS  - 2468-0249 (Electronic)
IS  - 2468-0249 (Linking)
VI  - 4
IP  - 8
DP  - 2019 Aug
TI  - Donor-Specific Antibodies in the Absence of Rejection Are Not a Risk Factor for 
      Allograft Failure.
PG  - 1057-1065
LID - 10.1016/j.ekir.2019.04.011 [doi]
AB  - INTRODUCTION: Donor-specific antibodies (DSAs) are considered an important risk 
      factor for graft injury and failure. However, there is limited information on 
      long-term outcomes for kidney transplant recipients with positive DSAs in the 
      absence of rejection on biopsy. METHODS: We evaluated all patients at the 
      University of Wisconsin who underwent a kidney allograft biopsy between January 
      1, 2013, and December 31, 2016. All patients with clinical indication or protocol 
      biopsies that were negative for acute rejection and lacked significant acute 
      pathological features were included in the study and divided into 2 groups based 
      on DSAs at the time of biopsy. There were a total of 1102 kidney biopsies during 
      the study period of which 587 fulfilled our selection criteria (DSA+, n = 192, 
      and DSA-, n = 395). The incidence of subsequent rejection and death-censored 
      graft failure (DCGF) were outcomes of interest. RESULTS: There was no difference 
      in acute (i + t + v + c4d + ptc + g = 0 in both groups) or chronic (ci + ct + cv 
      + cg = 2.4 +/- 2.2 vs. 2.7 +/- 2.4; cg = 0.12 +/- 0.48 vs. 0.13 +/- 0.48) Banff scores in 
      the index biopsy. Patients were followed for a mean of 33.1 +/- 16.8 months. 
      Kaplan-Meier analyses demonstrated a higher incidence of DCGF in DSA- group (n = 
      83) but this was not observed for subsequent rejection (n = 76). In multivariate 
      Cox regression analyses, the interval from transplant to biopsy, de novo DSA, and 
      younger age remained independently associated with increased risk of subsequent 
      rejection. Notably, there was no association between subsequent rejection or DSA 
      (pretransplant, de novo, persistant, Class I/II, MFI(sum), or MFI(max)) and graft 
      failure. CONCLUSION: This study suggests that in the absence of biopsy-proven 
      rejection and acute inflammation, human leukocyte antigen (HLA) DSAs are not 
      associated with increased risk of graft failure.
FAU - Parajuli, Sandesh
AU  - Parajuli S
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Joachim, Emily
AU  - Joachim E
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Alagusundaramoorthy, Sayee
AU  - Alagusundaramoorthy S
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Aziz, Fahad
AU  - Aziz F
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Blazel, Justin
AU  - Blazel J
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Garg, Neetika
AU  - Garg N
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Muth, Brenda
AU  - Muth B
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Mohamed, Maha
AU  - Mohamed M
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Redfield, Robert R
AU  - Redfield RR
AD  - Division of Transplantation, Department of Surgery, University of Wisconsin 
      School of Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Mandelbrot, Didier A
AU  - Mandelbrot DA
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
FAU - Zhong, Weixiong
AU  - Zhong W
AD  - Department of Pathology, University of Wisconsin School of Medicine and Public 
      Health, Madison, Wisconsin, USA.
FAU - Djamali, Arjang
AU  - Djamali A
AD  - Division of Nephrology, Department of Medicine, University of Wisconsin School of 
      Medicine and Public Health, Madison, Wisconsin, USA.
AD  - Division of Transplantation, Department of Surgery, University of Wisconsin 
      School of Medicine and Public Health, Madison, Wisconsin, USA.
LA  - eng
PT  - Journal Article
DEP - 20190418
PL  - United States
TA  - Kidney Int Rep
JT  - Kidney international reports
JID - 101684752
PMC - PMC6698321
OTO - NOTNLM
OT  - DSA
OT  - biopsies
OT  - graft survival
OT  - kidney transplant
EDAT- 2019/08/24 06:00
MHDA- 2019/08/24 06:01
PMCR- 2019/04/18
CRDT- 2019/08/24 06:00
PHST- 2019/02/14 00:00 [received]
PHST- 2019/03/10 00:00 [revised]
PHST- 2019/04/09 00:00 [accepted]
PHST- 2019/08/24 06:00 [entrez]
PHST- 2019/08/24 06:00 [pubmed]
PHST- 2019/08/24 06:01 [medline]
PHST- 2019/04/18 00:00 [pmc-release]
AID - S2468-0249(19)30158-5 [pii]
AID - 10.1016/j.ekir.2019.04.011 [doi]
PST - epublish
SO  - Kidney Int Rep. 2019 Apr 18;4(8):1057-1065. doi: 10.1016/j.ekir.2019.04.011. 
      eCollection 2019 Aug.