AUTHOR=Laboux Timothée , Lenain Rémi , Visentin Jonathan , Flahaut Gauthier , Chamley Paul , Provôt François , Top Isabelle , Kerleau Clarisse , Labalette Myriam , Choukroun Gabriel , Couzi Lionel , Blancho Gilles , Hazzan Marc , Maanaoui Mehdi 

TITLE=Impact of Preformed Donor-Specific Anti-HLA-Cw and Anti-HLA-DP Antibodies on Acute Antibody-Mediated Rejection in Kidney Transplantation

JOURNAL=Transplant International

VOLUME=36

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11416

DOI=10.3389/ti.2023.11416

ISSN=1432-2277

ABSTRACT=<p>Given the risk of rejection, the presence of preformed donor specific antibodies (DSA) contraindicates transplantation in most allocation systems. However, HLA-Cw and -DP DSA escape this censorship. We performed a multicentric observational study, in which the objective was to determinate risk factors of acute antibody-mediated rejection (aABMR) in recipients transplanted with preformed isolated Cw- or DP-DSA. Between 2010 and 2019, 183 patients were transplanted with a preformed isolated Cw- or DP-DSA (92 Cw-DSA; 91 DP-DSA). At 2 years, the incidence of aABMR was 12% in the Cw-DSA group, <italic>versus</italic> 28% in the DP-DSA group. Using multivariable Cox regression model, the presence of a preformed DP-DSA was associated with an increased risk of aABMR (HR = 2.32 [1.21–4.45 (<italic>p</italic> = 0.001)]) compared with Cw-DSA. We also observed a significant association between the DSA’s MFI on the day of transplant and the risk of aABMR (HR = 1.09 [1.08–1.18], <italic>p</italic> = 0.032), whatever the DSA was. Interaction term analysis found an increased risk of aABMR in the DP-DSA group compared with Cw-DSA, but only for MFI below 3,000. These results may plead for taking these antibodies into account in the allocation algorithms, in the same way as other DSA.</p>