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KMID : 0191120180330340217
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Journal of Korean Medical Science
2018 Volume.33 No. 34 p.217 ~ p.217
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Characteristics and Clinical Significance of De Novo Donor-Specific Anti-HLA Antibodies after Kidney Transplantation
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Jung Hee-Yeon
Kim Su-Hee
Seo Min-Young
Cho Sun-Young
Yang Young-Ae
Choi Ji-Young
Cho Jang-Hee
Park Sun-Hee
Kim Yong-Lim
Kim Hyung-Kee
Huh Seung
Won Dong-Il
Kim Chan-Duck
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Abstract
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Background: The association of de novo donor-specific anti-human leukocyte antigens (HLA) antibodies (DSA) and development of antibody-mediated rejection (AMR) in kidney transplant recipients (KTRs) is still undetermined.
Methods: We prospectively screened de novo DSA in 167 KTRs during 32 months after kidney transplantation (KT). Timing of DSA detection was at 3, 6, and 12 months post-transplant and annually thereafter and when clinically indicated. DSA levels were determined by Luminex assays and expressed as mean fluorescence intensity (MFI). We evaluated the incidence, characteristics of DSA, and association between DSA and tacrolimus trough levels or AMR.
Results: De novo DSA developed in 16 KTRs (9.6%) and acute AMR occurred more commonly in KTRs with de novo DSA compared to KTRs without de novo DSA (18.8% vs. 0%, P < 0.001). All de novo DSA were against class II antigens. The mean number of DSA was 1.8 ± 1.2 and the average MFI of DSA was 7,399 ± 5,470. Tacrolimus trough level during the first 0?2 months after KT was an independent predictor of DSA development (hazard ratio, 0.70; 95% confidence interval, 0.50?0.99; P = 0.043). No differences were found in the number of DSA, average MFI of DSA, and tacrolimus levels during the first year between de novo DSA-positive KTRs with AMR and those without AMR.
Conclusion: The results of our study suggest that monitoring of DSA and maintaining proper tacrolimus levels are essential to prevent AMR during the initial period after KT.
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KEYWORD
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Antibodies, Graft Rejection, Kidney Transplantation, Survival
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