Posttransplant de novo donor specific HLA antibody monitoring and clinical outcomes: a single-center experience

Objectives: Despite the improvements in early-term outcomes of kidney transplantation, late-term graft failure still remained as a critical problem. De novo donor specific antibodies (DSA) developing against direct human leukocyte antigens (HLA) are significant risk factors for shortened survival previously non-sensitized cases. The purpose this study is to evaluate clinical de DSA development transplant Methods: present included 121 (alive/cadaver: 106/15) 148 125/23) cases who were not sensitized (PRA and negative) undergone transplantation between August 2012-January 2018. DSAs without expected declines creatinine levels polyclinic follow-ups postoperative evaluated. Renal biopsy was performed encountered with >2000 mean fluorescence intensity (MFI) HLA-A, HLA-B, HLA-DR. Treatment protocol plasmapheresis+intravenous immunoglobulin (IVIG)+rituximab (in response) administered antibody-mediated rejection (AMR) detected by renal biopsy. In addition, presence non-DSA also evaluated identifying specificities anti-HLA antibody using Luminex single antigen beads recipient serum. Results: (antibodies HLA-DR HLA-DQ) monitored 23 DQ positivity 10 MFI values > 4000 2000-4000 8 2 cases, respectively. found 19 Biopsy due 2000 HLA-B findings acute humoral (AHR) Additionally, diagnosed 1 case that developed non-DSA. Two AHR although no or loss occurred these two Conclusions: fact routine monitoring all provided contribution our may contribute debates on necessity patients low immunological risk.