Clinical impact of the baseline donor-specific anti-HLA antibody measured by Luminex single antigen assay in living donor kidney transplant recipients after desensitization therapy

The aim of this study is to investigate the clinical impact of donor-specific anti-HLA-antibody (HLA-DSA) baseline levels, measured using the Luminex single-antigen assay (LSA), in living-donor kidney-transplantation (LDKT). Total 129 cases of LDKT were divided into 4 groups according to baseline mean fluorescence intensity (MFI) HLA-DSA values: Strong (n=6), >10,000; Moderate (n=8), 5,000–10,000; Weak (n=11), 1,000–5,000, Negative (n=104), <1,000. Pre-transplant desensitization (DSZ) was performed to decrease the MFI to weak or negative values before KT. Clinical outcomes in the 4 groups were compared. After DSZ, HLA-DSA decreased to weak or negative levels in all patients; Acute rejections developed more frequently in strong group (5/6 (83.3%)) compared to other three groups (P<0.05) and especially acute antibody-mediated rejection (AAMR) developed almost exclusively in strong group (4/6 (66.7%)). Strong HLA-DSA levels at baseline were more predictive of AAMR than either type of XM (complement-dependent lymphocytotoxicity or flow cytometry) in ROC analysis. Allograft function in this group showed significant deterioration during follow-up compared to the other groups. In conclusion, strong HLA-DSA levels at baseline are associated with worse allograft outcome even after successful desensitization; therefore, strict monitoring and strong maintenance immunosuppression may be required in such patients (read more) Print this post