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Multicenter Study
. 2021 Dec;34(12):2755-2768.
doi: 10.1111/tri.14119. Epub 2021 Oct 13.

Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study

Caroline Wehmeier  1 , Patrizia Amico  1 , Daniel Sidler  2 , Urs Wirthmüller  3 , Karine Hadaya  4 , Sylvie Ferrari-Lacraz  5 , Déla Golshayan  6 , Vincent Aubert  7 , Aurelia Schnyder  8 , Kata Sunic  9 , Thomas Schachtner  10 , Jakob Nilsson  11 , Stefan Schaub  1 ; Swiss Transplant Cohort Study
Collaborators, Affiliations
Free article
Multicenter Study

Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study

Caroline Wehmeier et al. Transpl Int. 2021 Dec.
Free article

Abstract

The aim of this study was to analyze first year renal outcomes in a nationwide prospective multicenter cohort comprising 2215 renal transplants, with a special emphasis on the presence of pre-transplant donor-specific HLA antibodies (DSA). All transplants had a complete virtual crossmatch and DSA were detected in 19% (411/2215). The investigated composite endpoint was a poor first-year outcome defined as (i) allograft failure or (ii) death or (iii) poor allograft function (eGFR ≤25 ml/min/1.73 m2 ) at one year. Two hundred and twenty-one (221/2215; 10%) transplants showed a poor first-year outcome. Rejection (24/70; 34%) was the most common reason for graft failure. First-year patient's death was rare (48/2215; 2%). There were no statistically significant differences between DSA-positive and DSA-negative transplants regarding composite and each individual endpoint, as well as reasons for graft failure and death. DSA-positive transplants experienced more frequently rejection episodes, mainly antibody-mediated rejection (both P < 0.0001). The combination of DSA and any first year rejection was associated with the overall poorest death-censored allograft survival (P < 0.0001). In conclusion, presence of pre-transplant DSA per se does not affect first year outcomes. However, DSA-positive transplants experiencing first year rejection are a high-risk population for poor allograft survival and may benefit from intense clinical surveillance.

Keywords: DSA; allograft failure; allograft loss; donor-specific HLA antibodies; rejection; renal transplantation.

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