Frequent development of subclinical chronic antibody-mediated rejection within 1year after renal transplantation with pre-transplant positive donor-specific antibodies and negative CDC crossmatches

Academic Article

Abstract

  • Although short-term graft survival has been improved by recent desensitization protocols including B cell depletion therapy, little is known about risk factors of chronic antibody-mediated rejection (CAMR) in HLA-incompatible (HLA-I) renal transplantation (RTx). Twenty-six HLA-I RTx with positive donor-specific antibodies (DSA) and negative T cell cytotoxic crossmatches were compared with 88 ABO-incompatible (ABO-I) and 207 ABO-identical/compatible (ABO-Id/C) RTx. The desensitization therapy consisted of mycophenolate mofetil, rituximab and double-filtration plasmapheresis. Protocol biopsies within 1. year revealed subclinical CAMR in 36% of HLA-I, 5% of ABO-I and 3% of ABO-Id/C, although clinical acute AMR was observed in 8%, 3% and 1%, respectively. The incidence of CAMR was not different between class I and class II DSA. Most of class I DSA (94%) changed to negative 1. year after RTx, whereas 77% of class II DSA remained positive. In addition, the remaining DRB ± DQB DSA caused CAMR in 80% of patients, while DQB DSA alone did not. The progress of subclinical CAMR within 1. year could not be circumvented by rituximab. Sustained class II (DRB ± DQB) DSA detection after RTx may pose a potential risk for developing CAMR, but negative change in class I DSA could also elicit CAMR. © 2013 American Society for Histocompatibility and Immunogenetics.
  • Published In

  • Human Immunology  Journal
  • Digital Object Identifier (doi)

    Author List

  • Yamanaga S; Watarai Y; Yamamoto T; Tsujita M; Hiramitsu T; Nanmoku K; Goto N; Takeda A; Morozumi K; Katayama A
  • Start Page

  • 1111
  • End Page

  • 1118
  • Volume

  • 74
  • Issue

  • 9