Pretransplant donor specific HLA antibodies in 4770 renal trans­plant recipients: A preliminary analysis of the PROCARE cohort

E.G. Kamburova, B.W. Wisse, I. Joosten, W.A. Allebes, A. van der Meer, L.B. Hilbrands, M.C. Baas, E. Spierings, C.E. Hack, F. van Reekum, A.D van Zuilen, M.C. Verhaar, M.L. Bots, A.C.A.D Drop, L. Plaisier, M.A.J Seelen, J.S.F Sanders, B.G Hepkema, A. Lambeck, L.B. Bungener, C. Roozendaal, M.G.J. Tilanus, J. Vanderlocht, C.E. Voorter, L. Wieten, E. van Duijnhoven, M. Gelens, M. Christiaans, F. van Ittersum, A. Nurmohamed, N.M. Lardy, W.T. Swelsen, K.A.M.I van Donselaar-van der Pant, N.C van der Weerd, I.J.M. ten Berge, F.J. Bemelman, A.J. Hoitsma, H.J.W. de Fijter, M.G.H. Betjes, D.L. Roelen, F.H.J. Claas, H.G. Otten

Chair(s): dr. Marije C. Baas, nefroloog, Radboudumc, Nijmegen & dr. Dries E. Braat, chirurg, LUMC

Thursday 10 march 2016

14:30 - 14:40h at Zaal 1 & 2

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie XII - Klinisch

The clinical significance of Luminex-detected donor-specific HLA antibodies (DSA) that do not cause a positive complement-dependent crossmatch is unclear. Currently there is no consensus on how DSA should be included in clinical decision making. As part of the national PROCARE consortium study, all kidney transplantations performed in the Netherlands between 1995-2005, are investigated. From the more than 6000 transplantations we were able to collect 4770 pretransplant sera. In this cohort, 60% of the recipients was male, mean age was 46 (±14) years, 731 (15%) patients received a re-transplant, and the mean follow-up time was 9.3 years (±5.3; range 0-20 years). 1494 patients received a kidney from a living donor, 828 from a donor after circulatory death (DCD), and 2448 from a brain dead donor (DBD). Of 2072 recorded graft losses, 818 were due to death with functioning graft. Historical pretransplant panel-reactive antibodies value (hPRA)≥5% was observed in 1553 (33%) patients. By Luminex-analysis, we determined that 501 (10%) sera contained antibodies against HLA class-I only, 398 (8%) against HLA class-II only and 609 (13%) against both HLA class-I and -II (positivity defined according to manufacturer’s instructions). Ten-year death-censored graft survival was 78% for patients without HLA antibodies. The presence of anti-HLA antibodies was associated with lower graft survival: 73% for anti-HLA class-I (p=0.018), 74% for anti-HLA class-II (p=0.087), and 64% for both anti-HLA class-I and -II (p<0.0001). Using donor HLA typing results, we will determine which sera contain pretransplant DSA. The relation between the effects of different levels and combinations of DSA with key clinical endpoints such as graft survival and function will be analysed.