The results of HLA-incompatible kidney transplantation according to pre-transplant crossmatch tests: Donor-specific antibody as a prominent predictor of acute rejection
- Authors
- Kwon, Hyunwook; Kim, Young Hoon; Kim, Jee Yeon; Choi, Ji Yoon; Shin, Sung; Jung, Joo Hee; Park, Su-Kil; Han, Duck Jong
- Issue Date
- May-2019
- Publisher
- WILEY
- Keywords
- allograft survival; anti-HLA antibodies; donor-specific antibodies; kidney transplantation
- Citation
- CLINICAL TRANSPLANTATION, v.33, no.5, pp.1 - 11
- Indexed
- SCIE
SCOPUS
- Journal Title
- CLINICAL TRANSPLANTATION
- Volume
- 33
- Number
- 5
- Start Page
- 1
- End Page
- 11
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/189482
- DOI
- 10.1111/ctr.13533
- ISSN
- 0902-0063
- Abstract
- Background Crossmatching (XM) between organ donors and recipients is correlated with clinical outcomes. This study evaluates the results of HLA-incompatible kidney transplant (HLA-i KT) according to pre-transplant XM modalities. Methods This study included 731 consecutive patients. HLA-i KT was defined as a transplant under conditions of complement-dependent cytotoxicity (CDC) XM positivity, flow-cytometric XM (FCXM) positivity, and/or maximal donor-specific antibody (DSA) mean fluorescence intensity (MFI) >= 5000. Results The incidence of antibody-mediated rejection (AMR) within 1 year after transplant was significantly higher in the HLA-i group than in the HLA compatible (HLA-c) group (15 vs 9 patients, 14.2% vs 1.4%; P 0.01). Multivariate analysis indicated that a DSA MFI >= 5000 (odds ratio [OR] = 2.63; 95% confidence interval [CI], 1.00-6.98; P = 0.05) was significantly associated with acute rejection (AR), whereas CDC (OR = 2.09; 95% CI, 0.55-7.99; P = 0.28) and FCXM positivity (OR = 2.07; 95% CI, 0.73-5.87; P = 0.17) were not. Similarly, DSA MFI >= 5000 (OR = 4.14; P = 0.02) was the only significant factor affecting the risk of AMR. Conclusions Of the various XM tests, DSA MFI >= 5000 was the most prominent predictor of AR in patients undergoing HLA-i KT.
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