Posttransplant donor-specific antibody characterization and kidney graft survival

Abstract This study was designed
to investigate the clinical relevance
of donor-specific antibodies (DSAbs)
and their influence on graft
survival. Among 106 patients who
underwent cadaveric kidney donor
transplantation and were monitored
by flow cytometry crossmatch
(FCXM) during the 1st posttransplantation
year, 25 (23.6%) resulted
positive for DS-Ab production.
During a 2-year follow up only 12 of
the 81 FCXM-negative patients
(14.8%) suffered rejection vs 17 of
25 FCXM-positive patients (68%;
P = 0.00 001). Correlating graft loss
to DS-Ab production, 9 FCXMpositive
patients lost the graft vs
only 1 among the FCXM-negative
patients. Aworse graft function was
evidenced in FCXM-positive subjects
who had also suffered rejection
episodes than in those which had
acute rejection but did not produce
DS-Abs. A high incidence of HLAAB
mismatches was found in
FCXM-positive subjects which produced
anti-class I antibodies. FCXM
appears useful in estimating posttransplant
alloimmune response.
Moreover our findings confirm the
harmful effects of anti-class I DSAbs
on long-term graft survival.