Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study

Publication

Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study

Journal Paper/Review - Oct 13, 2021

Wehmeier Caroline, Schaub Stefan, Nilsson Jakob, Schachtner Thomas, Sunic Kata, Schnyder Aurelia, Aubert Vincent, Golshayan Déla, Ferrari-Lacraz Sylvie, Hadaya Karine, Wirthmüller Urs, Sidler Daniel, Amico Patrizia, Swiss Transplant Cohort Study

Citation

Wehmeier C, Schaub S, Nilsson J, Schachtner T, Sunic K, Schnyder A, Aubert V, Golshayan D, Ferrari-Lacraz S, Hadaya K, Wirthmüller U, Sidler D, Amico P, Swiss Transplant Cohort Study. Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study. Transpl Int 2021; 34:2755-2768.

Type

Journal Paper/Review (English)

Journal

Transpl Int 2021; 34

Publication Date

Oct 13, 2021

Issn Electronic

1432-2277

Pages

2755-2768

Brief description/objective

The aim of this study was to analyze first year renal outcomes in a nationwide prospective multicenter cohort comprising 2215 renal transplants, with a special emphasis on the presence of pre-transplant donor-specific HLA antibodies (DSA). All transplants had a complete virtual crossmatch and DSA were detected in 19% (411/2215). The investigated composite endpoint was a poor first-year outcome defined as (i) allograft failure or (ii) death or (iii) poor allograft function (eGFR ≤25 ml/min/1.73 m ) at one year. Two hundred and twenty-one (221/2215; 10%) transplants showed a poor first-year outcome. Rejection (24/70; 34%) was the most common reason for graft failure. First-year patient's death was rare (48/2215; 2%). There were no statistically significant differences between DSA-positive and DSA-negative transplants regarding composite and each individual endpoint, as well as reasons for graft failure and death. DSA-positive transplants experienced more frequently rejection episodes, mainly antibody-mediated rejection (both P < 0.0001). The combination of DSA and any first year rejection was associated with the overall poorest death-censored allograft survival (P < 0.0001). In conclusion, presence of pre-transplant DSA per se does not affect first year outcomes. However, DSA-positive transplants experiencing first year rejection are a high-risk population for poor allograft survival and may benefit from intense clinical surveillance.