Abstract
Background It is an unresolved issue why some kidney transplant recipients with pretransplant donor-specific HLA antibodies (DSA) show a high transplant failure rate, whereas in other patients DSA do not harm the graft. We investigated whether help from preactivated T-cells might be necessary for DSA to exert a deleterious effect. Methods The impact of pretransplant DSA and immune activation marker soluble CD30 (sCD30) on 3-year graft survival was analyzed in 385 presensitized kidney transplant recipients. Findings A deleterious influence of pretransplant DSA on graft survival was evident only in patients who were positive for the immune activation marker sCD30. In the absence of sCD30 positivity, 3-year graft survival was virtually identical in patients with or without DSA (83.1 ± 3.9% and 84.3 ± 2.8%, P = 0.81). A strikingly lower 3-year graft survival rate of 62.1 ± 6.4% was observed in patients who were both sCD30 and DSA positive (HR 2.92, P < 0.001). Even in the presence of strong DSA with ≥ 5000 MFI, the 3-year graft survival rate was high if the recipients were sCD30 negative. Interpretation Pretransplant DSA have a significantly deleterious impact on graft survival only in the presence of high pretransplant levels of the activation marker sCD30.
Original language | English (US) |
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Pages (from-to) | 366-371 |
Number of pages | 6 |
Journal | EBioMedicine |
Volume | 9 |
DOIs | |
State | Published - 2016 |
Keywords
- Donor-specific antibodies
- Graft outcome
- HLA antibodies
- Kidney transplantation
- Single antigen bead
- sCD30
ASJC Scopus subject areas
- General Biochemistry, Genetics and Molecular Biology