Korean J Transplant.  2021 Mar;35(1):33-40. 10.4285/kjt.20.0052.

Clinical significance of de novo donor-specific antibody in kidney transplant recipients with chronic antibody-mediated rejection

• Park WY
• Kim Y
• Paek JH
• Jin K
• Han S

• KMID: 2514406
• DOI: http://doi.org/10.4285/kjt.20.0052

Abstract

Background
Chronic antibody-mediated rejection (CABMR) is an important cause of late graft loss. De novo donor-specific antibody (dnDSA) is an important prognostic factor for long-term allograft outcomes. However, the prognosis of CABMR based on the presence of dnDSA is uncertain.
Methods
We retrospectively analyzed 35 kidney transplant recipients with CABMR between 2010 and 2018. Fourteen recipients had no detectable DSA, and 21 recipients had detectable DSA. We investigated the pathologic findings at diagnosis of CABMR, allograft function 12 months later, related factors for allograft failure, and allograft survival rate based on the presence of dnDSA.
Results
The pathologic findings showed that acute and chronic changes were more severe in the dnDSA (+) group than in the dnDSA (–) group. There was no significant differ-ence in the allograft function 12 months after the diagnosis of CABMR and in the amount of proteinuria at diagnosis between the two groups. However, the death-censored graft survival rate was lower in the high-proteinuria group than in the low-proteinuria group in both groups. The treatment rate of recipients was higher in the dnDSA (+) group than in the dnDSA (–) group; however, there was no significant difference in the death-censored graft survival rate between the two groups.
Conclusions
Although the effect of dnDSA on the prognosis of CABMR is not clear, it would be important not to neglect treatment for CABMR with risk factors for allograft failure even without dnDSA. Continuous and rigorous surveillance of DSA and allograft function is needed in patients with CABMR.

Keyword

Kidney transplantation; Graft rejection; Antibodies; Risk factor; Treatment

Figure

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  Fig. 1 Comparison of death-censored overall graft survival rate (A) and death-censored graft survival rate after diagnosis of chronic antibody-mediated rejection (CABMR) (B) according to the presence of de novo donor-specific antibody (dnDSA).

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  Fig. 2 Comparison of death-censored graft survival rate between the high proteinuria and low proteinuria in the dnDSA (–) group (A) and dnDSA (+) group (B). CABMR, chronic active antibody-mediated rejection; dnDSA, de novo donor-specific antibody.

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  Fig. 3 Comparison of death-censored graft survival rate among DSA (–)+treatment (–), DSA (–)+treatment (+), DSA (+)+treatment (–), and DSA (+)+treatment (+). dnDSA, de novo donor-specific antibody.

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