Background Complement-fixing antibodies against donor HLA are considered a contraindication for kidney transplant. A modification of the IgG single-antigen bead (SAB) assay allows detection of anti-HLA antibodies that bind C3d. Because early humoral graft rejection is considered to be complement mediated, this SAB-based technique may provide a valuable tool in the pretransplant risk stratification of kidney transplant recipients. Methods Previously, we established that pretransplant donor-specific anti-HLA antibodies (DSAs) are associated with increased risk for long-term graft failure in complement-dependent cytotoxicity crossmatch-negative transplants. In this study, we further characterized the DSA-positive serum samples using the C3d SAB assay. Results Among 567 pretransplant DSA-positive serum samples, 97 (17%) contained at least one C3d-fixing DSA, whereas 470 (83%) had non-C3d-fixing DSA. At 10 years after transplant, patients with C3d-fixing antibodies had a death-censored, covariate-adjusted graft survival of 60%, whereas patients with non-C3d-fixing DSA had a graft survival of 64% (hazard ratio, 1.02; 95% confidence interval, 0.70 to 1.48 for C3d-fixing DSA compared with non-C3d-fixing DSA; P50.93). Patients without DSA had a 10-year graft survival of 78%. Conclusions The C3d-fixing ability of pretransplant DSA is not associated with increased risk for graft failure.

Additional Metadata
Persistent URL dx.doi.org/10.1681/ASN.2018020205, hdl.handle.net/1765/110071
Journal American Society of Nephrology. Journal
Rights No Subscription
Citation
Kamburova, E.G, Wisse, B.W, Joosten, I, Allebes, W.A, van der Meer, A, Hilbrands, L.B, … Otten, H.G. (2018). Pretransplant C3D-fixing donor-specific anti-HLA antibodies are not associated with increased risk for kidney graft failure. American Society of Nephrology. Journal, 29(9), 2279–2285. doi:10.1681/ASN.2018020205