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Kidney Week

Abstract: PO2404

The Clinical Significance of Preformed C1q-Binding Donor-Specific HLA Antibodies in Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lee, Sua, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Chung, Byung ha, Catholic University of Korea, Seoul, Korea (the Republic of)
  • Yang, Chul Woo, Catholic University of Korea, Seoul, Korea (the Republic of)
Background

The anti-human leukocyte antigen (HLA) antibodies are well known for risk factor of rejection or allograft loss in kidney transplantation (KT). De novo complement component 1q-binding donor-specific anti-HLA antibodies (C1q-binding DSAs) are already reported to be associated with an increased risk of acute allograft rejection in KT. This study investigated the clinical significance of identification of preformed C1q-binding DSAs for predicting graft outcomes in KT.

Methods

From December 2016 to December 2018, 323 recipients underwent KT at Seoul St. Mary's Hospital. If the results of panel reactive antibodies (PRA) were positive in the pre-transplant examination, DSAs and C1q-binding DSAs were performed using Luminex Single Antigen Bead Assay (SAB) at the same time. Graft outcomes in term as Chronic Kidney Disease-Epidemiology Collaboration estimated Glomerular Filtration Rate, biopsy proven acute rejection and graft survival were compared between recipients with preformed C1q-binding DSAs and recipients without preformed C1q-binding DSAs.

Results

Eighty-two of 323 recipients (25.4%) were evaluated DSAs and C1q-binding DSAs before transplantation. Among them, 40 recipients (48.8%) had preformed DSAs and 8 recipients (9.9%) had preformed C1q-binding DSAs. The higher MFI values of DSAs had higher prevalence of C1q-binding DSAs (9263.9 ± 3670.3 vs. 5955.3 ± 5245.5; p = 0.050). There was a strong correlation between the presence of DSAs against Class II and C1q-binding DSAs (p = 0.007; CI 95%, OR 9.333). Five of 21 patients (23.8%) with positive at least one of complement-dependent cytotoxicity (CDC) or flow cytometry crossmatch (FCXM) had preformed C1q-binding DSAs. There was a correlation between positivity of crossmatch and preformed C1q-binding DSAs (p = 0.024; CI 95%, OR 6.042). Four of 8 recipients (50%) in C1q-binding DSAs(+) group were confirmed acute antibody mediated rejection. C1q-binding DSAs(+) group had higher incidence of acute antibody mediated rejection than C1q-binding DSAs(-) group (p=0.044; CI 95%, OR 4.286).

Conclusion

The identification of preformed C1q-binding DSAs may be important in predicting acute antibody mediated rejection. Therefore, the surveillance such as protocol allograft biopsy is required for early detection of acute antibody mediated rejection after transplantation in patients with preformed C1q-binding DSAs.