Effect of De novo donor-specific antibodies on graft function in renal allograft recipients

• Main Authors: Ravi Kumar Singh, Ashwani Gupta, Vinant Bhargava, Anurag Gupta, Vaibhav Tiwari, Manish Malik, A K Bhalla, D S Rana, Monika Jain
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Transplantation
• Subjects: antibodies; graft; human leukocyte antigen; kidney transplant; luminex assay
• Online Access: http://www.ijtonline.in/article.asp?issn=2212-0017;year=2020;volume=14;issue=2;spage=130;epage=135;aulast=Singh
• ISSN: 2212-0017; 2212-0025

Background: De novo formation of donor-specific antibodies (DSA) against donor human leukocyte antigens (HLAs) class I and II has been recognized as one of the major risk factors for reduced allograft survival. This study aimed to detect the de novo DSA in renal transplanted recipients and their association with graft function. Methods: This was a retro-prospective observational study conducted from July 2017 to March 2019. The patients with pretransplant DSA-negative renal allograft and those who fulfilled the inclusion criteria were enrolled. Posttransplant, HLA-specific antibodies were tested using a panel reactive antibody (PRA) screen and a positive PRA screen was further tested by Luminex crossmatch assay. Posttransplant biochemical data were assessed for 6-, 12-, and 18-month follow-ups. Results: A total of 72 patients were included in this study, of which 63 were diagnosed as de novo DSA negative, and nine were diagnosed as de novo DSA positive. At 18-month follow-up, in the patients with de novo DSA positive, 55.55% patients showed positive DSA levels for HLA Class II, 33.33% patients showed border-line DSA levels for HLA Class II, and 11.11% patients showed border-line DSA levels for HLA Class I (P < 0.001). Proteinuria was high in de novo DSA-positive patients than de novo DSA negative while serum creatinine, estimated glomerular filtration rate, and tacrolimus level were comparable between groups at 6-, 12-, 18-month follow-up periods. Conclusion: The incidence of de novo DSA was developed in 12.5% of patients; however, there was no significant graft dysfunction.