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Pre-transplant crossmatch-negative donor-specific anti-HLA antibody predicts acute antibody-mediated rejection but not long-term outcomes in kidney transplantation: an analysis of the Korean Organ Transplantation Registry.
Lee, Haeun; Lee, Hanbi; Sun, In O; Park, Jung Hwan; Park, Jong-Won; Ban, Tae Hyun; Yang, Jaeseok; Kim, Myoung Soo; Yang, Chul Woo; Chung, Byung Ha.
Afiliación
  • Lee H; Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea.
  • Lee H; Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
  • Sun IO; Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea.
  • Park JH; Department of Nephrology, Konkuk University School of Medicine, Seoul, Republic of Korea.
  • Park JW; Department of Nephrology, Yeungnam University Hospital, Daegu, Republic of Korea.
  • Ban TH; Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.
  • Yang J; Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.
  • Kim MS; Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
  • Yang CW; Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
  • Chung BH; Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
Front Immunol ; 15: 1420351, 2024.
Article en En | MEDLINE | ID: mdl-39055708
ABSTRACT

Background:

Pre-transplant donor-specific anti-human leukocyte antigen antibody (HLA-DSA) is a recognized risk factor for acute antibody-mediated rejection (ABMR) and allograft failure. However, the clinical relevance of pre-transplant crossmatch (XM)-negative HLA-DSA remains unclear.

Methods:

We investigated the effect of XM-negative HLA-DSA on post-transplant clinical outcomes using data from the Korean Organ Transplantation Registry (KOTRY). This study included 2019 living donor kidney transplant recipients from 40 transplant centers in South Korea 237 with HLA-DSA and 1782 without HLA-DSA.

Results:

ABMR developed more frequently in patients with HLA-DSA than in those without (5.5% vs. 1.5%, p<0.0001). Multivariable analysis identified HLA-DSA as a significant risk factor for ABMR (odds ratio = 3.912, 95% confidence interval = 1.831-8.360; p<0.0001). Furthermore, the presence of multiple HLA-DSAs, carrying both class I and II HLA-DSAs, or having strong HLA-DSA were associated with an increased incidence of ABMR. However, HLA-DSA did not affect long-term clinical outcomes, such as allograft function and allograft survival, patient survival, and infection-free survival.

Conclusion:

Pre-transplant XM-negative HLA-DSA increased the risk of ABMR but did not affect long-term allograft outcomes. HLA-incompatible kidney transplantation in the context of XM-negative HLA-DSA appears to be feasible with careful monitoring and ensuring appropriate management of any occurrence of ABMR. Furthermore, considering the characteristics of pre-transplant XM-negative HLA-DSA, the development of a more detailed and standardized desensitization protocol is warranted.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prueba de Histocompatibilidad / Sistema de Registros / Trasplante de Riñón / Rechazo de Injerto / Antígenos HLA / Isoanticuerpos Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Front Immunol Año: 2024 Tipo del documento: Article Pais de publicación: Suiza
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prueba de Histocompatibilidad / Sistema de Registros / Trasplante de Riñón / Rechazo de Injerto / Antígenos HLA / Isoanticuerpos Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Front Immunol Año: 2024 Tipo del documento: Article Pais de publicación: Suiza