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Kidney Week

Abstract: PO2411

The Clinical Impact of Preformed HLA-DQ Donor-Specific Antibodies on Graft Outcomes in Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

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

De-novo HLA-DQ donor-specific antibody (DSA) has been identified as a risk factor for graft rejection and loss in kidney transplantation (KT). Recently, the impact of preformed HLA-DQ DSA has been discussed. This study aimed to investigate the clinical impact of preformed HLA-DQ DSA on graft outcomes.

Methods

We evaluated 990 recipients who underwent kideny transplantation at Seoul St. Mary's Hospital from January 2010 to July 2019. According to the result of DSA using luminex single antigen bead assay, recipients were classified as no DSA, only DQ, non-DQ, and DQ + non-DQ. Primary outcomes were the incidence of biopsy-proven acute rejection and the rate of death-censored graft loss.

Results

In total cohort, 611 recipients (61.7%) and 379 recipients (38.3%) underwent living-donor KT and deceased-donor KT, respectively. Recipients were classified as no DSA (909 recipients, 91.8%), only DQ (18 recipients, 1.8 %), non-DQ (57 recipients, 6.3%), and DQ + non-DQ (6 recipients, 0.7%). The overall incidence of acute rejection and acute antibody-mediated rejection (AMR) were 20.3% and 7.5%. Only DQ, non-DQ, and DQ + non-DQ group had significantly higher the incidence of acute AMR compared to no DSA group (p < 0.05, respectively). There was no significant difference in the incidence of acute AMR between sensitized groups. There was no difference in the rate of death-censored graft loss between groups. In univariate Cox regression analysis, all of 3 groups with DSA were associated with high risk of acute AMR (Only DQ: HR 5.051; CI 95%, p = 0.002, non-DQ: HR 6.005; CI 95%, p < 0.001, DQ + non-DQ: HR 7.748; CI 95%, p = 0.005, respectively). HLA-DQ DSA and other DSAs (HLA-A, HLA-B, HLA-DR) had a tendency to interact with acute AMR, although no statistical significance (p = 0.055).

Conclusion

Preformed HLA-DQ DSA is associated with the development of acute rejection, especially acute AMR. Therefore, the identification of preformed HLA-DQ DSA may be necessary to improve graft outcomes.