Complement-Binding Donor-Specific Anti-HLA Antibodies: Biomarker for Immunologic Risk Stratification in Pediatric Kidney Transplantation Recipients

Vaka K. Sigurjonsdottir, Natasha Purington, Abanti Chaudhuri, Bing M. Zhang, Marcelo Fernandez-Vina, Runolfur Palsson, Neeraja Kambham, Vivek Charu, Kim Piburn, Lynn Maestretti, Anika Shah, Amy Gallo, Waldo Concepcion, Paul C. Grimm

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Antibody-mediated rejection is a common cause of early kidney allograft loss but the specifics of antibody measurement, therapies and endpoints have not been universally defined. In this retrospective study, we assessed the performance of risk stratification using systematic donor-specific antibody (DSA) monitoring. Included in the study were children who underwent kidney transplantation between January 1, 2010 and March 1, 2018 at Stanford, with at least 12-months follow-up. A total of 233 patients were included with a mean follow-up time of 45 (range, 9–108) months. Median age at transplant was 12.3 years, 46.8% were female, and 76% had a deceased donor transplant. Fifty-two (22%) formed C1q-binding de novo donor-specific antibodies (C1q-dnDSA). After a standardized augmented immunosuppressive protocol was implemented, C1q-dnDSA disappeared in 31 (58.5%). Graft failure occurred in 16 patients at a median of 54 (range, 5–83) months, of whom 14 formed dnDSA. The 14 patients who lost their graft due to rejection, all had persistent C1q-dnDSA. C1q-binding status improved the individual risk assessment, with persistent; C1q binding yielding the strongest independent association of graft failure (hazard ratio, 45.5; 95% confidence interval, 11.7–177.4). C1q-dnDSA is more useful than standard dnDSA as a noninvasive biomarker for identifying patients at the highest risk of graft failure.

Original languageEnglish (US)
Article number10158
JournalTransplant International
Volume35
DOIs
StatePublished - Mar 16 2022
Externally publishedYes

Keywords

  • antibody-mediated rejection
  • children
  • immunosuppression
  • kidney allograft
  • transplant outcomes

ASJC Scopus subject areas

  • Transplantation

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