Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 18, 2025; 15(3): 104308
Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.104308
Impact of low-level pretransplant donor-specific antibodies detected by the Luminex platform on acute rejection and long-term graft survival
Khawar Abbas, Muhammed Mubarak, Wajiha Musharraf, Abdul Rauf Hafeez, Tahir Aziz, Mirza Naqi Zafar
Khawar Abbas, Wajiha Musharraf, Department of Transplant Immunology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sind, Pakistan
Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Abdul Rauf Hafeez, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Tahir Aziz, Department of Transplantation, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Mirza Naqi Zafar, Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Co-corresponding authors: Khawar Abbas and Muhammed Mubarak.
Author contributions: Abbas K and Mubarak M contributed equally to the conception and study design; Abbas K, Mubarak M, Musharaf W, and Hafeez AF performed relevant research and participated in the primary and final drafting; Mubarak M, Aziz T, and Zafar MN critically reviewed and approved the final manuscript.
Institutional review board statement: The present study was approved by the Institutional Review Board of SIUT (SIUT-ERC-2020/A-417), and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent statement: All patients provided written informed consent.
Conflict-of-interest statement: All authors declared that they have no conflicts of interest related to this work.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Khawar Abbas, Professor, Department of Transplant Immunology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sind, Pakistan. drkhawar_imuno@yahoo.com
Received: December 18, 2024
Revised: March 2, 2025
Accepted: March 10, 2025
Published online: September 18, 2025
Processing time: 121 Days and 22.6 Hours
Abstract
BACKGROUND

The Luminex platform, where beads are coated with single human leukocyte antigens (HLA), detects HLA antibodies with higher sensitivity and specificity compared to complement-dependent cytotoxicity (CDC) assay and flow cross-match (FCXM). The clinical significance of donor-specific antibodies (DSAs) detected by this method is still under investigation.

AIM

To report the impact of low-level pretransplant DSAs detected by the Luminex platform on the rates of acute rejection (AR), allograft function, and long-term graft survival.

METHODS

This retrospective study was conducted at the Immunology Department of Sindh Institute of Urology and Transplantation, Karachi, Pakistan between January 2013 and December 2022. During this period 2714 patients were transplanted. Out of these patients 78 (2.9%) patients had low-level DSAs detected by the Luminex flow beads method and were negative by CDC and FCXM with their donors. All recipients received ABO-compatible live-related kidney transplants. All patients had a minimum follow-up of 1 year. Graft rejection rates, graft function, and patient and graft survival were analyzed. The estimated glomerular filtration rate was calculated by the full CKD-EPI formula.

RESULTS

The mean age of all recipients was 29.57 ± 10.11 years and 34.53 ± 9.09 years for the donors. In 48 (61.5%) patients, the cause of end-stage kidney disease was unknown. DSA against HLA class I was detected in 36 (46.1%) patients, class II in 35 (44.8%) patients, and both class I and II in 7 (8.9%) patients. AR episodes were encountered in 8 (10.3%) cases. Seven (87.5%) had T cell mediated rejection (type IA) and one acute antibody-mediated rejection. Antibody status was re-evaluated at the time of biopsy-proven ARs. Five (62.5%) patients lost their DSAs, while three (37.5%) had persistent DSAs. The mean estimated glomerular filtration rate at 1 year was 80.56 ± 27.48 mL/min/1.73 m2 and at the last follow-up 73.41 ± 28.80 mL/min/1.73 m2. The 1-year and 10-year patient and graft survival rates were 99% and 79% and 95% and 75%, respectively. During the follow-up period, 10 (12.8%) patients died, 8 patients had a functioning graft, and 2 patients had failed grafts. Eight patients died due to cardiopulmonary arrest, and two died due to sepsis with failed grafts.

CONCLUSION

Patients with pretransplant low-level DSAs on Luminex without CDC and FCXM reactivity had good allograft outcomes at 1 year and 10 years as long as they are induced with biological agents and given potent maintenance immunosuppressants.

Keywords: Pretransplant; Donor-specific antibodies; Luminex; Kidney transplant; Rejection; Graft outcomes

Core Tip: Pretransplant low-level donor-specific antibodies (DSAs) detected by the Luminex platform are associated with favorable graft outcomes after 1 year and 10 years in kidney transplant recipients. This study highlighted the appropriate immunosuppressive induction and maintenance protocols. These patients experienced low rates of acute rejection and sustained satisfactory long-term graft function and survival. The majority of patients who experienced acute rejection showed a resolution of DSAs, underscoring the dynamic nature of antibodies. These findings support the clinical relevance of Luminex-detected low-level DSAs and reinforce the efficacy of contemporary immunosuppressive strategies in optimizing graft survival in this subset of transplant recipients.