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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2016; 6(4): 689-696
Published online Dec 24, 2016. doi: 10.5500/wjt.v6.i4.689
Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cw vs anti-A and/or -B antibodies
Sofia Santos, Jorge Malheiro, Sandra Tafulo, Leonídio Dias, Rute Carmo, Susana Sampaio, Marta Costa, Andreia Campos, Sofia Pedroso, Manuela Almeida, La Salete Martins, Castro Henriques, António Cabrita
Sofia Santos, Jorge Malheiro, Leonídio Dias, Marta Costa, Andreia Campos, Sofia Pedroso, Manuela Almeida, La Salete Martins, Castro Henriques, António Cabrita, Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, 4099-001 Porto, Portugal
Sandra Tafulo, Centro do Sangue e Transplantação do Porto, IPST, 4200-139 Porto, Portugal
Rute Carmo, Susana Sampaio, Department of Nephrology, Hospital São João, 4200-319 Porto, Portugal
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Institutional review board statement: The Institutional Review Board at Centro Hospitalar do Porto approved this study.
Informed consent statement: All involved persons (subjects or legally authorized representative) gave their informed consent (written or verbal, as appropriate) prior to study inclusion.
Conflict-of-interest statement: None of the authors has any potential conflicts of interest related to this study.
Data sharing statement: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC-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.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sofia Santos, MD, Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
sofia.fersantos@gmail.com
Telephone: +351-22-2077500 Fax: +351-22-2033189
Received: June 27, 2016
Peer-review started: June 29, 2016
First decision: September 28, 2016
Revised: November 12, 2016
Accepted: November 27, 2016
Article in press: November 29, 2016
Published online: December 24, 2016
Processing time: 170 Days and 5.7 Hours
AIM
To analyze the clinical impact of preformed antiHLA-Cw vs antiHLA-A and/or -B donor-specific antibodies (DSA) in kidney transplantation.
METHODS
Retrospective study, comparing 12 patients transplanted with DSA exclusively antiHLA-Cw with 23 patients with preformed DSA antiHLA-A and/or B.
RESULTS
One year after transplantation there were no differences in terms of acute rejection between the two groups (3 and 6 cases, respectively in the DSA-Cw and the DSA-A-B groups; P = 1). At one year, eGFR was not significantly different between groups (median 59 mL/min in DSA-Cw group, compared to median 51 mL/min in DSA-A-B group, P = 0.192). Moreover, kidney graft survival was similar between groups at 5-years (100% in DSA-Cw group vs 91% in DSA-A-B group, P = 0.528). The sole independent predictor of antibody mediated rejection (AMR) incidence was DSA strength (HR = 1.07 per 1000 increase in MFI, P = 0.034). AMR was associated with shortened graft survival at 5-years, with 75% and 100% grafts surviving in patients with or without AMR, respectively (Log-rank P = 0.005).
CONCLUSION
Our data indicate that DSA-Cw are associated with an identical risk of AMR and impact on graft function in comparison with “classical” class I DSA.
Core tip: The clinical importance of preformed antiHLA-Cw donor-specific antibodies (DSA) in kidney transplant patients remains controversial, so we performed a retrospective study comparing 12 patients with DSA exclusively antiHLA-Cw with 23 patients with preformed DSA antiHLA-A and/or B. Antibody-mediated rejection occurrence and graft survival frequency, respectively, at one and at five years of follow-up, were comparable between groups. Our data support a similar deleterious impact considering DSA-Cw or DSA-A/-B in terms of risk of AMR and impact on graft function.
