Evaluation of C1q Status and Titer of De Novo Donor-Specific Antibodies as Predictors of Allograft Survival

C. Wiebe, A. J. Gareau, D. Pochinco, I. W. Gibson, J. Ho, P. E. Birk, T. Blydt-Hansen, M. Karpinski, A. Goldberg, L. Storsley, D. N. Rush, P. W. Nickerson

Research output: Contribution to journalArticlepeer-review

Abstract

De novo donor-specific antibodies (dnDSAs) that develop after renal transplantation are independent predictors of allograft loss. However, it is unknown if dnDSA C1q status or titer at the time of first detection can independently predict allograft loss. In a consecutive cohort of 508 renal transplant recipients, 70 developed dnDSAs. Histologic and clinical outcomes were correlated with the C1q assay or dnDSA titer. C1q positivity correlated with dnDSA titer (p < 0.01) and mean fluorescence intensity (p < 0.01) and was more common in class II versus class I dnDSAs (p < 0.01). C1q status correlated with tubulitis (p = 0.02) and C4d status (p = 0.03) in biopsies at the time of dnDSA development, but not T cell–mediated rejection (TCMR) or antibody-mediated rejection (ABMR). De novo DSA titer correlated with Banff g, i, t, ptc, C4d scores, TCMR (p < 0.01) and ABMR (p < 0.01). Post-dnDSA graft loss was observed more frequently in recipients with C1q-positve dnDSA (p < 0.01) or dnDSA titer ≥ 1:1024 (p ≤ 0.01). However, after adjustment for clinical phenotype and nonadherence in multivariate models, neither C1q status nor dnDSA titer were independently associated with allograft loss, questioning the utility of these assays at the time of dnDSA development.

Original languageEnglish (US)
Pages (from-to)703-711
Number of pages9
JournalAmerican Journal of Transplantation
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Keywords

  • alloantibody
  • antibody biology
  • clinical research/practice
  • immunobiology
  • kidney (allograft) function/dysfunction
  • kidney transplantation/nephrology
  • organ transplantation in general
  • rejection: antibody-mediated (ABMR)
  • rejection: subclinical
  • translational research/science

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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