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Clinical significance of the presence of antihuman leukocyte antigen-donor specific antibody in kidney transplant recipients with allograft dysfunction

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Background/Aims: This study investigated the clinical significance of detecting anti-human leukocyte antigen-donor specific antibody (HLA-DSA) in kidney transplant recipients (KTRs) requiring indication biopsy owing to allograft dysfunction. Methods: We analyzed the presence of HLA-DSA in 210 KTRs who took indication biopsy. We divided these cases into two groups, HLA-DSA (+) (n = 52) and HLA-DSA (–) (n = 158) group, and compared the clinical characteristics, pathological findings, and clinical outcomes of the two groups. Results: The rates of retransplant, pretransplant sensitization, and HLA-mismatch were significantly higher in HLA-DSA (+) group than in HLA-DSA (–) group (p < 0.05 for each comparison). In histologic finding, all types of rejections were more frequent in the former group. Besides, scores of both the T-cell injury markers such as tubulitis, interstitial inf lammation, and vasculitis and antibody- mediated injury markers such as peritubular C4d deposition and microvascular inflammation (glomerulitis plus peritubular capillaritis) were higher in HLA-DSA (+) group (p < 0.05 for each). Notably, allograft outcomes were worse in HLA-DSA (+) group. Further, multivariate analysis showed that presence of HLADSA, advanced interstitial fibrosis/tubular atrophy (interstitial fibrosis plus tubular atrophy ≥ 2), and allograft rejection in biopsy were independent risk factors for allograft failure. Conclusions: The results of this study showed that presence of HLA-DSA in a case of allograft dysfunction adversely influences allograft outcome, and its detection, irrespective of the result of the allograft biopsy, necessitates intensive monitoring and treatment.

Abstract

Background/Aims: This study investigated the clinical significance of detecting anti-human leukocyte antigen-donor specific antibody (HLA-DSA) in kidney transplant recipients (KTRs) requiring indication biopsy owing to allograft dysfunction. Methods: We analyzed the presence of HLA-DSA in 210 KTRs who took indication biopsy. We divided these cases into two groups, HLA-DSA (+) (n = 52) and HLA-DSA (–) (n = 158) group, and compared the clinical characteristics, pathological findings, and clinical outcomes of the two groups. Results: The rates of retransplant, pretransplant sensitization, and HLA-mismatch were significantly higher in HLA-DSA (+) group than in HLA-DSA (–) group (p < 0.05 for each comparison). In histologic finding, all types of rejections were more frequent in the former group. Besides, scores of both the T-cell injury markers such as tubulitis, interstitial inf lammation, and vasculitis and antibody- mediated injury markers such as peritubular C4d deposition and microvascular inflammation (glomerulitis plus peritubular capillaritis) were higher in HLA-DSA (+) group (p < 0.05 for each). Notably, allograft outcomes were worse in HLA-DSA (+) group. Further, multivariate analysis showed that presence of HLADSA, advanced interstitial fibrosis/tubular atrophy (interstitial fibrosis plus tubular atrophy ≥ 2), and allograft rejection in biopsy were independent risk factors for allograft failure. Conclusions: The results of this study showed that presence of HLA-DSA in a case of allograft dysfunction adversely influences allograft outcome, and its detection, irrespective of the result of the allograft biopsy, necessitates intensive monitoring and treatment.

참고문헌 (31)

  1. Wiebe C, "Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant", Am J Transplant, 12, pp.1157~1167 (2012)[DOI]
  2. Lee PC, "All chronic rejection failures of kidney transplants were preceded by the development of HLA antibodies", Transplantation, 74, pp.1192~1194 (2002)[DOI]
  3. Sellares J, "Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence", Am J Transplant, 12, pp.388~399 (2012)[DOI]
  4. Cosio FG, "Transplant glomerulopathy", Am J Transplant, 8, pp.492~496 (2008)[DOI]
  5. Everly MJ, "Incidence and impact of de novo donor-specific alloantibody in primary renal allografts", Transplantation, 95, pp.410~417 (2013)[DOI]
  6. Dieplinger G, "Impact of de novo donor-specific HLA antibodies detected by Luminex solid-phase assay after transplantation in a group of 88 consecutive living-donor renal transplantations", Transpl Int, 27, pp.60~68 (2014)[DOI]
  7. Dieplinger G, "Changes in successive measures of de novo donor-specific anti-human leukocyte antigen antibodies intensity and the development of allograft dysfunction", Transplantation, 98, pp.1097~1104 (2014)[DOI]
  8. Chung BH, "Comparison of clinical outcome between high and low baseline anti-ABO antibody titers in ABO-incompatible kidney transplantation", Ren Fail, 33, pp.150~158 (2011)[DOI]
  9. Solez K, "Banff 07 classification of renal allograft pathology: updates and future directions", Am J Transplant, 8, pp.753~760 (2008)[DOI]
  10. Haas M, "Banff 2013 meeting report: inclusion of C4d-negative antibody-mediated rejection and antibody-associated arterial lesions", Am J Transplant, 14, pp.272~283 (2014)[DOI]
  11. Cooper JE, "Clinical significance of post kidney transplant de novo DSA in otherwise stable grafts", Clin Transpl, pp.359~364 (2011)
  12. Chung BH, "Clinical impact of the baseline donor-specific anti-human leukocyte antigen antibody measured by Luminex single antigen assay in living donor kidney transplant recipients after desensitization therapy", Transpl Int, 27, pp.49~59 (2014)[DOI]
  13. Chung BH, "Impact of ABO incompatibility on the development of acute antibody-mediated rejection in kidney transplant recipients presensitized to HLA", PLoS One, 10, pp.e0123638~ (2015)[DOI]
  14. Armstrong KA, "Obesity is associated with worsening cardiovascular risk factor profiles and proteinuria progression in renal transplant recipients", Am J Transplant, 5, pp.2710~2718 (2005)[DOI]
  15. Vlad G, "Relevance of different antibody detection methods for the prediction of antibody- mediated rejection and deceased-donor kidney allograft survival", Hum Immunol, 70, pp.589~594 (2009)[DOI]
  16. Caro-Oleas JL, "Clinical relevance of HLA donor-specific antibodies detected by single antigen assay in kidney transplantation", Nephrol Dial Transplant, 27, pp.1231~1238 (2012)[DOI]
  17. Hwang HS, "Antibody monitoring system to support the single-antigen Luminex assay in donor-specific antibody detection", Hum Immunol, 73, pp.370~375 (2012)[DOI]
  18. Ntokou IS, "Long-term follow up for anti-HLA donor specific antibodies postrenal transplantation: high immunogenicity of HLA class II graft molecules", Transpl Int, 24, pp.1084~1093 (2011)[DOI]
  19. Gloor JM, "Histologic findings one year after positive crossmatch or ABO blood group incompatible living donor kidney transplantation", Am J Transplant, 6, pp.1841~1847 (2006)[DOI]
  20. Ishida H, "Influence of preoperative anti-HLA antibodies on shortand long-term graft survival in recipients with or without rituximab treatment", Transpl Int, 27, pp.371~382 (2014)[DOI]
  21. Lachmann N, "Anti-human leukocyte antigen and donor-specific antibodies detected by luminex posttransplant serve as biomarkers for chronic rejection of renal allografts", Transplantation, 87, pp.1505~1513 (2009)[DOI]
  22. Nankivell BJ, "The natural history of chronic allograft nephropathy", N Engl J Med, 349, pp.2326~2333 (2003)[DOI]
  23. Thomas WR, "T and B cell responses to HDM allergens and antigens", Immunol Res, 37, pp.187~199 (2007)[DOI]
  24. Ramiscal RR, "T-cell subsets in the germinal center", Immunol Rev, 252, pp.146~155 (2013)[DOI]
  25. Qi H, "From SAP-less T cells to helpless B cells and back: dynamic T-B cell interactions underlie germinal center development and function", Immunol Rev, 247, pp.24~35 (2012)[DOI]
  26. Naemi FM, "Anti-donor HLA class I antibodies: pathways to endothelial cell activation and cell-mediated allograft rejection", Transplantation, 96, pp.258~266 (2013)[DOI]
  27. Lobo LJ, "Donor-specific antibodies are associated with antibody-mediated rejection, acute cellular rejection, bronchiolitis obliterans syndrome, and cystic fibrosis after lung transplantation", J Heart Lung Transplant, 32, pp.70~97 (2013)[DOI]
  28. Sis B, "A new diagnostic algorithm for antibody-mediated microcirculation inflammation in kidney transplants", Am J Transplant, 12, pp.1168~1179 (2012)[DOI]
  29. de Kort H, "Microcirculation inflammation associates with outcome in renal transplant patients with de novo donor-specific antibodies", Am J Transplant, 13, pp.485~492 (2013)[DOI]
  30. Loupy A, "The impact of donor-specific anti-HLA antibodies on late kidney allograft failure", Nat Rev Nephrol, 8, pp.348~357 (2012)
  31. Aubert V, "Low levels of human leukocyte antigen donor-specific antibodies detected by solid phase assay before transplantation are frequently clinically irrelevant", Hum Immunol, 70, pp.580~583 (2009)[DOI]

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