The role of donor-specific anti-HLA antibodies in kidney transplant survival revisited!

E.G. Kamburova, B.W. Wisse, I. Joosten, W.A. Allebes, A. van der Meer, L.B. Hilbrands, M.C. Baas, E. Spierings, C.E. Hack, F.E. van Reekum, A.D van Zuilen, M.C. Verhaar, M.L. Bots, A.C.A.D Drop, L. Plaisier, M.A.J Seelen, J.S. Sanders, B.G Hepkema, A.J. Lambeck, L.B. Bungener, C. Roozendaal, M.G.J. Tilanus, C.E. Voorter, L. Wieten, E.M. van Duijnhoven, M.A.C.J. Gelens, M.H.L. Christiaans, F. van Ittersum, A. Nurmohamed, N.M. Lardy, W.T. Swelsen, K.A.M.I. van der Pant, N.C van der Weerd, I.J.M. ten Berge, F.J. Bemelman, A.J. Hoitsma, P.J.M van der Boog, J.W. de Fijter, M.G.H. Betjes, S. Heidt, D.L. Roelen, F.H.J. Claas, H.G. Otten

Chair(s): Prof. dr. L.B. Hilbrands & H.M. Kwakkel-van Erp

Wednesday 8 march 2017

18:18 - 18:30h at Willem Pijperzaal

Categories: Parallel - Klinisch

Parallel session: Parallelsessie VI - Klinisch 1 - HLA-antilichamen en immunomodulatie

The presence of donor-specific anti-HLA antibodies (DSA) is associated with increased risk of graft failure after renal transplantation. However, clinical relevance of DSA for graft survival is mainly studied in deceased-donor and not living-donor transplantations. In this Dutch multicenter study we investigated the impact of non-donor-specific HLA antibodies (NDSA) and DSA, assessed by using Luminex single antigen bead assay, on long-term graft survival in 3237 deceased- and 1487 living-donor renal transplantations. We found that after deceased-donor transplantation, patients with NDSA or DSA had a 10-years graft survival of 71% and 63%, which was significantly lower (P<0.0001) compared to the 77% graft survival rate of patients without HLA-antibodies. In contrast, (N)DSA had minimal effect on living-donor transplantations. In deceased-donor recipients, especially the combination of DSA but also NDSA against HLA class-I and -II had detrimental effects, showing a long-term graft survival of 54% and 67% respectively. Furthermore, both DSA and NDSA were associated with graft failure after 1 year, while only DSA showed an association with graft failure thereafter. In conclusion, DSA are associated with increased risk for graft failure but only in deceased- and not living-donor transplantations. In addition, on the long-term (N)DSA especially against HLA class-I and II are associated with increased graft failure in deceased-donor transplantations. Based on these results we suggest that patients with (N)DSA should be treated as a patients for higher risk for graft rejection unless transplanted with living-donor transplants.