PMID- 36217531
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221012
IS  - 2468-0249 (Electronic)
IS  - 2468-0249 (Linking)
VI  - 7
IP  - 10
DP  - 2022 Oct
TI  - Isolated Pre-existing HLA-DP Donor-Specific Antibodies are Associated With Poorer 
      Outcomes in Renal Transplantation.
PG  - 2251-2263
LID - 10.1016/j.ekir.2022.07.014 [doi]
AB  - INTRODUCTION: The importance of donor-specific antibodies (DSAs) in renal 
      transplantation has long been recognized, but the significance of human leukocyte 
      antigen (HLA)-DP antibodies remains less clear. We performed a retrospective 
      single center study of renal transplants with pre-existing isolated HLA-DP-DSAs 
      to assess clinical outcomes. METHODS: Twenty-three patients with isolated 
      HLA-DP-DSAs were compared with 3 control groups as follows: standard 
      immunological risk (calculated reaction frequency [cRF] < 85%, no current or 
      historical DSA, no repeat mismatched antigens with previous transplants, n = 46), 
      highly sensitized (cRF > 85%, n = 27), and patients with HLA-DP antibodies that 
      were not donor-specific (n = 18). Univariate and multivariate analyses were 
      performed comparing antibody-mediated rejection (ABMR)-free and graft survival. 
      Factors in the final multivariable models included patient group, % cRF, B-cell 
      flow crossmatch (BFXM) positivity and regrafts. RESULTS: Over a median follow-up 
      of 1197 days, 65% of HLA-DP-DSA patients had ABMR on indication biopsies, and 30% 
      of HLA-DP-DSA patients lost their graft. Pre-existing HLA-DP DSAs remained the 
      single factor associated with ABMR after multivariable analysis (hazard ratio 
      [HR] = 9.578, P = 0.012). Patients with HLA-DP DSAs had increased microvascular 
      scores (P = 0.0346) and worse transplant glomerulopathy (P = 0.015) on biopsy 
      compared with the standard immunological risk group. Furthermore, flow crossmatch 
      (FXM) positivity did not help inform on the risk of graft failure or ABMR in 
      patients with preformed DP-DSA. CONCLUSION: Transplants with pre-existing 
      HLA-DP-DSAs should be considered high risk. Routine laboratory tests are unable 
      to further risk stratify these patients. Recipients should be considered for 
      intensified immunosuppression and closely monitored.
CI  - (c) 2022 International Society of Nephrology. Published by Elsevier Inc.
FAU - Seitz, Adrienne
AU  - Seitz A
AD  - Renal Transplant Unit, St James's University Hospital, Leeds, UK.
AD  - Transplant Immunology, St James's University Hospital, Leeds, UK.
FAU - Mounsey, Katherine
AU  - Mounsey K
AD  - Transplant Immunology, St James's University Hospital, Leeds, UK.
FAU - Hughes, Pamela
AU  - Hughes P
AD  - Transplant Immunology, St James's University Hospital, Leeds, UK.
FAU - Cullen, Katherine
AU  - Cullen K
AD  - Transplant Immunology, St James's University Hospital, Leeds, UK.
FAU - Welberry Smith, Matthew
AU  - Welberry Smith M
AD  - Renal Transplant Unit, St James's University Hospital, Leeds, UK.
FAU - Daga, Sunil
AU  - Daga S
AD  - Renal Transplant Unit, St James's University Hospital, Leeds, UK.
FAU - Carter, Clive
AU  - Carter C
AD  - Transplant Immunology, St James's University Hospital, Leeds, UK.
FAU - Clark, Brendan
AU  - Clark B
AD  - Transplant Immunology, St James's University Hospital, Leeds, UK.
FAU - Baker, Richard
AU  - Baker R
AD  - Renal Transplant Unit, St James's University Hospital, Leeds, UK.
LA  - eng
PT  - Journal Article
DEP - 20220803
PL  - United States
TA  - Kidney Int Rep
JT  - Kidney international reports
JID - 101684752
PMC - PMC9546735
OTO - NOTNLM
OT  - HLA-DP
OT  - antibody-mediated rejection
OT  - donor-specific antibodies
EDAT- 2022/10/12 06:00
MHDA- 2022/10/12 06:01
PMCR- 2022/08/03
CRDT- 2022/10/11 01:49
PHST- 2021/09/27 00:00 [received]
PHST- 2022/07/08 00:00 [revised]
PHST- 2022/07/11 00:00 [accepted]
PHST- 2022/10/11 01:49 [entrez]
PHST- 2022/10/12 06:00 [pubmed]
PHST- 2022/10/12 06:01 [medline]
PHST- 2022/08/03 00:00 [pmc-release]
AID - S2468-0249(22)01513-3 [pii]
AID - 10.1016/j.ekir.2022.07.014 [doi]
PST - epublish
SO  - Kidney Int Rep. 2022 Aug 3;7(10):2251-2263. doi: 10.1016/j.ekir.2022.07.014. 
      eCollection 2022 Oct.