Pre-transplant soluble CD30 in combination with total DSA but not pre-transplant C1q-DSA predicts antibody-mediated graft loss in presensitized high-risk kidney transplant recipients

• Verfasst von: Schäfer, Sebastian Markus [VerfasserIn]
• Verfasst von: Süsal, Caner [VerfasserIn]
• Verfasst von: Opelz, Gerhard [VerfasserIn]
• Verfasst von: Döhler, Bernd [VerfasserIn]
• Verfasst von: Becker, Luis Eduardo [VerfasserIn]
• Verfasst von: Klein, Katrin [VerfasserIn]
• Verfasst von: Waldherr, Rüdiger [VerfasserIn]
• Verfasst von: Schemmer, Peter [VerfasserIn]
• Verfasst von: Beimler, Jörg [VerfasserIn]
• Verfasst von: Zeier, Martin [VerfasserIn]
• Verfasst von: Morath, Christian [VerfasserIn]
• Verfasst von: Macher-Göppinger, Stephan [VerfasserIn]
• Titel: Pre-transplant soluble CD30 in combination with total DSA but not pre-transplant C1q-DSA predicts antibody-mediated graft loss in presensitized high-risk kidney transplant recipients
• Verf.angabe: S.M. Schaefer, C. Süsal, G. Opelz, B. Döhler, L.E. Becker, K. Klein, S. Sickmüller, R. Waldherr, S. Macher‐Goeppinger, P. Schemmer, J. Beimler, M. Zeier & C. Morath
• E-Jahr: 2016
• Jahr: 03 January 2016
• Umfang: 11 S.
• Teil: volume:87
• Teil: year:2016
• Teil: number:2
• Teil: pages:89-99
• Teil: extent:11
• Fussnoten: Gesehen am 29.11.2019
• Titel Quelle: Enthalten in: HLA
• Ort Quelle: Oxford : Wiley, 2016
• Jahr Quelle: 2016
• Band/Heft Quelle: 87(2016), 2, Seite 89-99
• ISSN Quelle: 2059-2310
• DOI: doi:10.1111/tan.12735
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: antibody-mediated rejection
• Sach-SW: B-cell
• Sach-SW: C1q
• Sach-SW: donor-specific antibodies
• Sach-SW: human leukocyte antigen
• Sach-SW: increased soluble CD30
• Sach-SW: kidney
• Sach-SW: rejection
• Sach-SW: transplantation
• K10plus-PPN: 1683694104

Abstract

Presensitized kidney transplant recipients are at high-risk for early antibody-mediated rejection. We studied the impact of pre- and post-transplant donor-specific human leukocyte antigen (HLA) antibodies (DSA) and T-cell-activation on the occurrence of antibody-mediated rejection episodes (AMR) and graft loss (AMR-GL) in a unique cohort of 80 desensitized high-risk kidney transplant recipients. Patients with pre-transplant DSA demonstrated more AMR episodes than patients without DSA, but did not show a significantly increased rate of AMR-GL. The rates of AMR and AMR-GL were not significantly increased in patients with complement split product (C1q)-binding pre-transplant DSA. Pre-transplant C1q-DSA became undetectable post-transplant in 11 of 13 (85%) patients; 2 (18%) of these 11 patients showed AMR but no AMR-GL. In contrast, the post-transplant presence of C1q-DSA was associated with significantly higher rates of AMR (86 vs 33 vs 0%; P < 0.001) and AMR-GL (86 vs 0 vs 0%; log-rank P < 0.001) compared with post-transplant DSA without C1q-binding or the absence of DSA. Patients with both pre-transplant DSA and evidence of pre-transplant T-cell-activation as indicated by soluble CD30-positivity showed a significantly increased risk for AMR-GL [HR = 11.1, 95% confidence interval (CI) = 1.68-73.4; log-rank P = 0.013]. In these high-risk patients, AMR-GL was associated with total DSA in combination with T-cell-activation pre-transplant, and de novo or persistent C1q-binding DSA post-transplant.