Reducing de novo donor-specific antibody levels during acute rejection diminishes renal allograft loss

M. J. Everly, J. J. Everly, L. J. Arend, P. Brailey, B. Susskind, A. Govil, A. Rike, P. Roy-Chaudhury, G. Mogilishetty, R. R. Alloway, A. Tevar, E. S. Woodle

Research output: Contribution to journalArticlepeer-review

Abstract

The effect of de novo DSA detected at the time of acute cellular rejection (ACR) and the response of DSA levels to rejection therapy on renal allograft survival were analyzed. Kidney transplant patients with acute rejection underwent DSA testing at rejection diagnosis with DSA levels quantified using Luminex single-antigen beads. Fifty-two patients experienced acute rejection with 16 (31%) testing positive for de novo DSA. Median follow-up was 27.0 ± 17.4 months postacute rejection. Univariate analysis of factors influencing allograft survival demonstrated significance for African American race, DGF, cytotoxic PRA >20% (current) and/or >50% (peak), de novo DSA, C4d and repeat transplantation. Multivariate analysis showed only de novo DSA (6.6-fold increased allograft loss risk, p = 0.017) to be significant. Four-year allograft survival was higher with ACR (without DSA) (100%) than mixed acute rejection (ACR with DSA/C4d) (65%) or antibody-mediated rejection (35%) (p < 0.001). Patients with >50% reduction in DSA within 14 days experienced higher allograft survival (p = 0.039). De novo DSAs detected at rejection are associated with reduced allograft survival, but prompt DSA reduction was associated with improved allograft survival. DSA should be considered a potential new end point for rejection therapy.

Original languageEnglish (US)
Pages (from-to)1063-1071
Number of pages9
JournalAmerican Journal of Transplantation
Volume9
Issue number5
DOIs
StatePublished - May 2009

Keywords

  • Allograft survival
  • Antibody-mediated rejection
  • Antihumoral therapy
  • C4d
  • Donor-specific antibodies
  • Mixed acute rejection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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