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2018

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cc-by-nc-nd (c) International Society of Nephrology, 2018
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/172488

Combining sensitive crossmatch assays with donor/recipient human leukocyte antigen eplet matching predicts living-donor kidney transplant outcome

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Recurs relacionat

https://doi.org/10.1016/j.ekir.2018.03.015

Resum

Introduction: Despite the different assays available for immune-risk stratification before living-donor kidney transplantation (LDKT), the precise type and number of tests to perform remain uncertain. Methods: In a cohort of 330 consecutive LDKT patients, all of which were complement-dependent cyto- toxicity (CDC) crossmatch negative, we retrospectively analyzed the impact on main clinical outcomes of most sensitive immunoassays (complement-dependent cytotoxicity panel-reactive antibody [CDC-PRA], flow cytometry crossmatch [FC-XM], donor-specific antibodies [DSAs], and their complement-binding capacity DSA-C3d]), together with donor/recipient HLA eplet matching. Mean follow-up was 67 months (range 24 190 months). Results: Of 330 patients, 35 (11%) showed a CDC-PRA >20%; 17 (5%) FC-XMþ; 30 (9%) DSAþ, 18(5%) DSA- C3dþ, with low overlapping results (10 patients positive in all donor-specific tests). Unlike HLA allele compatibility, the mean number of HLA class II eplet mismatches was higher in LDKT patients with positive baseline test results. DSA-C3dþ showed higher mean fluorescence intensity (MFI) DSA, with a cut-off MFI of 6192 accurately predicting complement fixation (area under the curve 1⁄4 0.85, P 1⁄4 0.008). Although all assays were associated with acute rejection (AR), only DSA-C3dþ (odds ratio [OR] 1⁄4 6.64, P 1⁄4 0.038) or high MFI-DSA (OR 1⁄4 7.54, P 1⁄4 0.038) independently predicted AR. Likewise, poorly HLA class II eplet matched patients were at higher risk for AR, particularly patients with negative baseline test results (OR 1⁄4 1.14, P 1⁄4 0.019). Finally, previous AR and FC-XMþ/DSAþ, regardless of C3d positivity, indepen- dently predicted graft loss. Conclusion: Combining FC-XM and solid-phase assays with the evaluation of donor/recipient HLA eplet mismatches, are most accurate tools for immune-risk stratification prior LDKT.

Matèries

Trasplantament renal, Leucòcits, Antígens

Matèries (anglès)

Kidney transplantation, Leucocytes, Antigens

Citació

Col·leccions

Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

MENEGHINI, Maria, et al. Combining sensitive crossmatch assays with donor/recipient human leukocyte antigen eplet matching predicts living-donor kidney transplant outcome. Kidney International Reports. 2018. Vol. 3, num. 4, pags. 926-938. ISSN 2468-0249. [consulted: 14 of August of 2026]. Available at: https://hdl.handle.net/2445/172488

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