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Pretransplant C3D-fixing donor-specific anti-HLA antibodies are not associated with increased risk for kidney graft failure

Elena G. Kamburova, Bram W. Wisse, Irma Joosten, Wil A. Allebes, Arnold van der Meer, Luuk B. Hilbrands, Marije C. Baas, Eric Spierings, Cornelis E. Hack, Franka E. van Reekum, Arjan D. van Zuilen, Marianne C. Verhaar, Michiel L. Bots, Adriaan C.A.D. Drop, Loes Plaisier, Marc A.J. Seelen, Jan Stephan Sanders, Bouke G. Hepkema, Annechien J.A. Lambeck, Laura B. Bungener, Caroline Roozendaal, Marcel G.J. Tilanus, Christina E. Voorter, Lotte Wieten, Elly M. van Duijnhoven, Mariëlle A.C.J. Gelens, Maarten H.L. Christiaans, Frans J. van Ittersum, Shaikh A. Nurmohamed, Neubury M. Lardy, Wendy Swelsen, Karlijn A.M.I. van der Pant, Neelke C. van der Weerd, Ineke J.M. ten Berge, Frederike J. Bemelman, Andries J. Hoitsma, Paul J.M. van der Boog, Johan W. de Fijter, Michiel G.H. Betjes, Sebastiaan Heidt, Dave L. Roelen, Frans H. Claas and Henny G. Otten

Published: 01/09/2018

Abstract

Background Complement-fixing antibodies against donor HLA are considered a contraindication for kidney transplant. A modification of the IgG single-antigen bead (SAB) assay allows detection of anti-HLA antibodies that bind C3d. Because early humoral graft rejection is considered to be complement mediated, this SAB-based technique may provide a valuable tool in the pretransplant risk stratification of kidney transplant recipients.Methods Previously, we established that pretransplant donor-specific anti-HLA antibodies (DSAs) are associated with increased risk for long-term graft failure in complement-dependent cytotoxicity crossmatch-negative transplants. In this study, we further characterized the DSA-positive serum samples using the C3d SAB assay.Results Among 567 pretransplant DSA-positive serum samples, 97 (17%) contained at least one C3d-fixing DSA, whereas 470 (83%) had non-C3d-fixing DSA. At 10 years after transplant, patients with C3d-fixing antibodies had a death-censored, covariate-adjusted graft survival of 60%, whereas patients with non-C3d-fixing DSA had a graft survival of 64% (hazard ratio, 1.02; 95% confidence interval, 0.70 to 1.48 for C3d-fixing DSA compared with non-C3d-fixing DSA; P=0.93). Patients without DSA had a 10-year graft survival of 78%.Conclusions The C3d-fixing ability of pretransplant DSA is not associated with increased risk for graft failure.

Full Access Link: Journal of the American Society of Nephrology