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. 2010 Mar;10(3):582-9.
doi: 10.1111/j.1600-6143.2009.02985.x. Epub 2010 Jan 29.

Baseline donor-specific antibody levels and outcomes in positive crossmatch kidney transplantation

J M Gloor  1 , J L Winters, L D Cornell, L A Fix, S R DeGoey, R M Knauer, F G Cosio, M J Gandhi, W Kremers, M D Stegall
Affiliations
Free article

Baseline donor-specific antibody levels and outcomes in positive crossmatch kidney transplantation

J M Gloor et al. Am J Transplant. 2010 Mar.
Free article

Abstract

Renal transplant candidates with donor-specific alloantibody (DSA) have increased risk of antibody-mediated allograft injury. The goal of this study was to correlate the risk of antibody-mediated rejection (AMR), transplant glomerulopathy (TG) and graft survival with the baseline DSA level (prior to initiation of pretransplant conditioning). These analyses include 119 positive crossmatch (+XM) compared to 70 negative crossmatch (-XM) transplants performed between April 2000 and July 2007. Using a combination of cell-based crossmatch tests, DSA level was stratified into very high +XM, high +XM, low +XM and -XM groups. In +XM transplants, increasing DSA level was associated with increased risk for AMR (HR = 1.76 [1.51, 2.07], p = 0.0001) but not TG (p = 0.18). We found an increased risk for both early and late allograft loss associated with very high DSA (HR = 7.71 [2.95, 20.1], p = 0.0001). Although lower DSA recipients commonly developed AMR and TG, allograft survival was similar to that of -XM patients (p = 0.31). We conclude that the baseline DSA level correlates with risk of early and late alloantibody-mediated allograft injury. With current protocols, very high baseline DSA patients have high rates of AMR and poor long-term allograft survival highlighting the need for improved therapy for these candidates.

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