The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.

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Keywords alloantibody, clinical research/practice, graft survival, kidney failure/injury, kidney transplantation, kidney transplantation/nephrology, living donor
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Journal American Journal of Transplantation
Kamburova, E.G, Wisse, B.W, Joosten, I, Allebes, W.A, van der Meer, A, Hilbrands, L.B, … Otten, H.G. (2018). Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant. American Journal of Transplantation, 18(9), 2274–2284. doi:10.1111/ajt.14709