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Dokumenttyp:
Journal Article
Autor(en):
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; Görg, Siegfried; Guthoff, Martina; Habicht, Antje; Hallensleben, Michael; Heinemann, Falko M; Hessler, Nicole; Hugo, Christian; Kaufmann, Matthias; Kauke, Teresa; Koch, Martina; König, Inke R; Kurschat, Christine; Lehmann, Claudia; Marget, Matthias; Mühlfeld, Anja; N...     »
Titel:
Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study.
Abstract:
BACKGROUND AND OBJECTIVES: The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The 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. RESULTS: Pretransplant 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. CONCLUSIONS: Preformed 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.
Zeitschriftentitel:
Clin J Am Soc Nephrol
Jahr:
2019
Band / Volume:
14
Heft / Issue:
7
Seitenangaben Beitrag:
1056-1066
Volltext / DOI:
doi:10.2215/CJN.13401118
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/31213508
Print-ISSN:
1555-9041
TUM Einrichtung:
Fachgebiet Nephrologie (Prof. Heemann)
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