Ziemann, Malte, Altermann, Wolfgang, Angert, Katharina, Arns, Wolfgang, Bachmann, Anette, Bakchoul, Tamam, Banas, Bernhard, von Borstel, Annette, Budde, Klemens, Ditt, Vanessa, Einecke, Gunilla, Eisenberger, Ute, Feldkamp, Thorsten, Goerg, Siegfried, Guthoff, Martina ORCID: 0000-0002-4294-980X, Habicht, Antje, Hallensleben, Michael, Heinemann, Falko M., Hessler, Nicole, Hugo, Christian, Kaufmann, Matthias, Kauke, Teresa, Koch, Martina, Koenig, Inke R., Kurschat, Christine, Lehmann, Claudia, Marget, Matthias, Muehlfeld, Anja, Nitschke, Martin, da Silva, Luiza Pego, Quick, Carmen, Rahmel, Axel, Rath, Thomas, Reinke, Petra ORCID: 0000-0003-0771-4375, Renders, Lutz, Sommer, Florian, Spriewald, Bernd, Staeck, Oliver, Stippel, Dirk ORCID: 0000-0002-1107-0907, Suesal, Caner, Thiele, Bernhard, Zecher, Daniel and Lachmann, Nils (2019). Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study. Clin. J. Am. Soc. Nephrol., 14 (7). S. 1056 - 1067. WASHINGTON: AMER SOC NEPHROLOGY. ISSN 1555-905X

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Abstract

Background and objectivesThe prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation.Design, setting, participants, & measurementsThe outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively.ResultsPretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA >= 3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA >= 3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA >= 3000 MFI.ConclusionsPreformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Ziemann, MalteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Altermann, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Angert, KatharinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arns, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bachmann, AnetteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bakchoul, TamamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Banas, BernhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Borstel, AnnetteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Budde, KlemensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ditt, VanessaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Einecke, GunillaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eisenberger, UteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Feldkamp, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goerg, SiegfriedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guthoff, MartinaUNSPECIFIEDorcid.org/0000-0002-4294-980XUNSPECIFIED
Habicht, AntjeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hallensleben, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heinemann, Falko M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hessler, NicoleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hugo, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kaufmann, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kauke, TeresaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koch, MartinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koenig, Inke R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kurschat, ChristineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lehmann, ClaudiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marget, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muehlfeld, AnjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nitschke, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
da Silva, Luiza PegoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Quick, CarmenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rahmel, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rath, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reinke, PetraUNSPECIFIEDorcid.org/0000-0003-0771-4375UNSPECIFIED
Renders, LutzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sommer, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Spriewald, BerndUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Staeck, OliverUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stippel, DirkUNSPECIFIEDorcid.org/0000-0002-1107-0907UNSPECIFIED
Suesal, CanerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thiele, BernhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zecher, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lachmann, NilsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-135416
DOI: 10.2215/CJN.13401118
Journal or Publication Title: Clin. J. Am. Soc. Nephrol.
Volume: 14
Number: 7
Page Range: S. 1056 - 1067
Date: 2019
Publisher: AMER SOC NEPHROLOGY
Place of Publication: WASHINGTON
ISSN: 1555-905X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
INCOMPATIBLE KIDNEY-TRANSPLANTATION; INDUCTION THERAPY; CROSS-MATCH; ABO; RITUXIMAB; OUTCOMES; RISK; RECIPIENTS; EFFICACYMultiple languages
Urology & NephrologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13541

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