Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation

Abstract Background The effect of low‐level pretransplant donor‐specific antibody (DSA) on kidney transplant outcomes is not well described. The goal of this study was to compare outcomes among patients of varying immunologic risk, based on the level of pretransplant DSA. Methods We retrospectively...

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Autores principales:	Sandesh Parajuli, Natalie M. Bath, Luis Hidalgo, Glen Leverson, Neetika Garg, Robert R. Redfield III, Didier A. Mandelbrot
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	processes transplantation Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/6d8e7127d34947fd8e3f06d8138864c9
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spelling	oai:doaj.org-article:6d8e7127d34947fd8e3f06d8138864c92021-11-12T19:57:15ZImpact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation2050-452710.1002/iid3.504https://doaj.org/article/6d8e7127d34947fd8e3f06d8138864c92021-12-01T00:00:00Zhttps://doi.org/10.1002/iid3.504https://doaj.org/toc/2050-4527Abstract Background The effect of low‐level pretransplant donor‐specific antibody (DSA) on kidney transplant outcomes is not well described. The goal of this study was to compare outcomes among patients of varying immunologic risk, based on the level of pretransplant DSA. Methods We retrospectively reviewed all adult kidney transplant recipients who had undergone a transplant at our center between January 2013 and May 2017. Patients were grouped as negative DSA (mean fluorescence intensity, [MFISUM < 100]), low‐level DSA (MFISUM 100–1000), and positive DSA (MFISUM > 1000). Rejection, infection, graft, and patient survival were outcomes measured. Results Of 952 patients, 82.1% had negative DSA, 10.7% had low‐level DSA, and 7.1% had positive DSA. The positive DSA group had the highest rate of antibody‐mediated rejection (10.3%), followed by low‐level DSA (7.8%) and the negative DSA group (4.5%) (p = .034). The rate of BK viremia was highest in the positive DSA group (39.7%), followed by the low‐level group (30.4%) and the negative DSA group (25.6%), (p = .025). None of the other outcomes, including graft or patient survival, were different between the groups. Conclusion While low‐level DSA should not prevent proceeding with kidney transplantation, it should not be ignored. Future studies are needed to investigate the long‐term effects of varying levels of pre‐transplant DSA on outcomes.Sandesh ParajuliNatalie M. BathLuis HidalgoGlen LeversonNeetika GargRobert R. Redfield IIIDidier A. MandelbrotWileyarticleprocessestransplantationImmunologic diseases. AllergyRC581-607ENImmunity, Inflammation and Disease, Vol 9, Iss 4, Pp 1508-1519 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	processes transplantation Immunologic diseases. Allergy RC581-607
spellingShingle	processes transplantation Immunologic diseases. Allergy RC581-607 Sandesh Parajuli Natalie M. Bath Luis Hidalgo Glen Leverson Neetika Garg Robert R. Redfield III Didier A. Mandelbrot Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation
description	Abstract Background The effect of low‐level pretransplant donor‐specific antibody (DSA) on kidney transplant outcomes is not well described. The goal of this study was to compare outcomes among patients of varying immunologic risk, based on the level of pretransplant DSA. Methods We retrospectively reviewed all adult kidney transplant recipients who had undergone a transplant at our center between January 2013 and May 2017. Patients were grouped as negative DSA (mean fluorescence intensity, [MFISUM < 100]), low‐level DSA (MFISUM 100–1000), and positive DSA (MFISUM > 1000). Rejection, infection, graft, and patient survival were outcomes measured. Results Of 952 patients, 82.1% had negative DSA, 10.7% had low‐level DSA, and 7.1% had positive DSA. The positive DSA group had the highest rate of antibody‐mediated rejection (10.3%), followed by low‐level DSA (7.8%) and the negative DSA group (4.5%) (p = .034). The rate of BK viremia was highest in the positive DSA group (39.7%), followed by the low‐level group (30.4%) and the negative DSA group (25.6%), (p = .025). None of the other outcomes, including graft or patient survival, were different between the groups. Conclusion While low‐level DSA should not prevent proceeding with kidney transplantation, it should not be ignored. Future studies are needed to investigate the long‐term effects of varying levels of pre‐transplant DSA on outcomes.
format	article
author	Sandesh Parajuli Natalie M. Bath Luis Hidalgo Glen Leverson Neetika Garg Robert R. Redfield III Didier A. Mandelbrot
author_facet	Sandesh Parajuli Natalie M. Bath Luis Hidalgo Glen Leverson Neetika Garg Robert R. Redfield III Didier A. Mandelbrot
author_sort	Sandesh Parajuli
title	Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation
title_short	Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation
title_full	Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation
title_fullStr	Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation
title_full_unstemmed	Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation
title_sort	impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/6d8e7127d34947fd8e3f06d8138864c9
work_keys_str_mv	AT sandeshparajuli impactoflowlevelpretransplantdonorspecificantibodiesonoutcomesafterkidneytransplantation AT nataliembath impactoflowlevelpretransplantdonorspecificantibodiesonoutcomesafterkidneytransplantation AT luishidalgo impactoflowlevelpretransplantdonorspecificantibodiesonoutcomesafterkidneytransplantation AT glenleverson impactoflowlevelpretransplantdonorspecificantibodiesonoutcomesafterkidneytransplantation AT neetikagarg impactoflowlevelpretransplantdonorspecificantibodiesonoutcomesafterkidneytransplantation AT robertrredfieldiii impactoflowlevelpretransplantdonorspecificantibodiesonoutcomesafterkidneytransplantation AT didieramandelbrot impactoflowlevelpretransplantdonorspecificantibodiesonoutcomesafterkidneytransplantation
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Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation

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