Intermediate-Term Graft Loss After Renal Transplantation is Associated With Both Donor-Specific Antibody and Acute Rejection
BACKGROUNDRenal transplant recipients with de novo DSA (dDSA) experience higher rates of rejection and worse graft survival than dDSA-free recipients. This study presents a single-center review of dDSA monitoring in a large, multi-ethnic cohort of renal transplant recipients. METHODSThe authors perf...
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| Veröffentlicht in: | Transplantation 2014-03, Vol.97 (5), p.534-540 |
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| creator | DeVos, Jennifer M Gaber, Ahmed Osama Teeter, Larry D Graviss, Edward A Patel, Samir J Land, Geoffrey A Moore, Linda W Knight, Richard J |
| description | BACKGROUNDRenal transplant recipients with de novo DSA (dDSA) experience higher rates of rejection and worse graft survival than dDSA-free recipients. This study presents a single-center review of dDSA monitoring in a large, multi-ethnic cohort of renal transplant recipients.
METHODSThe authors performed a nested case-control study of adult kidney and kidney-pancreas recipients from July 2007 through July 2011. Cases were defined as dDSA-positive whereas controls were all DSA-negative transplant recipients. DSA were determined at 1, 3, 6, 9, and 12 months posttransplant, and every 6 months thereafter.
RESULTSOf 503 recipients in the analysis, 24% developed a dDSA, of whom 73% had dDSA against DQ antigen. Median time to dDSA was 6.1 months (range 0.2–44.6 months). After multivariate analysis, African American race, kidney-pancreas recipient, and increasing numbers of human leukocyte antigen mismatches were independent risk factors for dDSA. Recipients with dDSA were more likely to suffer an acute rejection (AR) (35% vs. 10%, P |
| doi_str_mv | 10.1097/01.TP.0000438196.30790.66 |
| format | Article |
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METHODSThe authors performed a nested case-control study of adult kidney and kidney-pancreas recipients from July 2007 through July 2011. Cases were defined as dDSA-positive whereas controls were all DSA-negative transplant recipients. DSA were determined at 1, 3, 6, 9, and 12 months posttransplant, and every 6 months thereafter.
RESULTSOf 503 recipients in the analysis, 24% developed a dDSA, of whom 73% had dDSA against DQ antigen. Median time to dDSA was 6.1 months (range 0.2–44.6 months). After multivariate analysis, African American race, kidney-pancreas recipient, and increasing numbers of human leukocyte antigen mismatches were independent risk factors for dDSA. Recipients with dDSA were more likely to suffer an acute rejection (AR) (35% vs. 10%, P<0.001), an antibody-mediated AR (16% vs. 0.3%, P<0.001), an AR ascribed to noncompliance (8% vs. 2%, P=0.001), and a recurrent AR (6% vs. 1%, P=0.002) than dDSA-negative recipients. At a median follow-up of 31 months, the death-censored actuarial graft survival of dDSA recipients was worse than the DSA-free cohort (P=0.002). Yet, for AR-free recipients, there was no difference in graft survival between cohorts (P=0.66).
CONCLUSIONSDevelopment of dDSA was associated with an increased incidence of graft loss, yet the detrimental effect of dDSA was limited in the intermediate term to recipients with AR.</description><identifier>ISSN: 0041-1337</identifier><identifier>ISSN: 1534-6080</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/01.TP.0000438196.30790.66</identifier><identifier>PMID: 24595116</identifier><language>eng</language><publisher>United States: by Lippincott Williams & Wilkins</publisher><subject>Adult ; Antibodies - blood ; Antibodies - immunology ; Black or African American ; Black People ; Case-Control Studies ; Cohort Studies ; Female ; Follow-Up Studies ; Graft Rejection - epidemiology ; Graft Rejection - ethnology ; Graft Rejection - immunology ; Hispanic or Latino ; HLA Antigens - immunology ; Humans ; Incidence ; Kaplan-Meier Estimate ; Kidney Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Pancreas Transplantation ; Risk Factors ; Time Factors ; Tissue Donors ; Transplantation ; White People</subject><ispartof>Transplantation, 2014-03, Vol.97 (5), p.534-540</ispartof><rights>2014 by Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4226-c9a5b7040bc1ef36d30884d2efebc7674cf3dc568d19329405ff3dc93ccdd1323</citedby><cites>FETCH-LOGICAL-c4226-c9a5b7040bc1ef36d30884d2efebc7674cf3dc568d19329405ff3dc93ccdd1323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24595116$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DeVos, Jennifer M</creatorcontrib><creatorcontrib>Gaber, Ahmed Osama</creatorcontrib><creatorcontrib>Teeter, Larry D</creatorcontrib><creatorcontrib>Graviss, Edward A</creatorcontrib><creatorcontrib>Patel, Samir J</creatorcontrib><creatorcontrib>Land, Geoffrey A</creatorcontrib><creatorcontrib>Moore, Linda W</creatorcontrib><creatorcontrib>Knight, Richard J</creatorcontrib><title>Intermediate-Term Graft Loss After Renal Transplantation is Associated With Both Donor-Specific Antibody and Acute Rejection</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>BACKGROUNDRenal transplant recipients with de novo DSA (dDSA) experience higher rates of rejection and worse graft survival than dDSA-free recipients. This study presents a single-center review of dDSA monitoring in a large, multi-ethnic cohort of renal transplant recipients.
METHODSThe authors performed a nested case-control study of adult kidney and kidney-pancreas recipients from July 2007 through July 2011. Cases were defined as dDSA-positive whereas controls were all DSA-negative transplant recipients. DSA were determined at 1, 3, 6, 9, and 12 months posttransplant, and every 6 months thereafter.
RESULTSOf 503 recipients in the analysis, 24% developed a dDSA, of whom 73% had dDSA against DQ antigen. Median time to dDSA was 6.1 months (range 0.2–44.6 months). After multivariate analysis, African American race, kidney-pancreas recipient, and increasing numbers of human leukocyte antigen mismatches were independent risk factors for dDSA. Recipients with dDSA were more likely to suffer an acute rejection (AR) (35% vs. 10%, P<0.001), an antibody-mediated AR (16% vs. 0.3%, P<0.001), an AR ascribed to noncompliance (8% vs. 2%, P=0.001), and a recurrent AR (6% vs. 1%, P=0.002) than dDSA-negative recipients. At a median follow-up of 31 months, the death-censored actuarial graft survival of dDSA recipients was worse than the DSA-free cohort (P=0.002). Yet, for AR-free recipients, there was no difference in graft survival between cohorts (P=0.66).
CONCLUSIONSDevelopment of dDSA was associated with an increased incidence of graft loss, yet the detrimental effect of dDSA was limited in the intermediate term to recipients with AR.</description><subject>Adult</subject><subject>Antibodies - blood</subject><subject>Antibodies - immunology</subject><subject>Black or African American</subject><subject>Black People</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - ethnology</subject><subject>Graft Rejection - immunology</subject><subject>Hispanic or Latino</subject><subject>HLA Antigens - immunology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Pancreas Transplantation</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Tissue Donors</subject><subject>Transplantation</subject><subject>White People</subject><issn>0041-1337</issn><issn>1534-6080</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1PHCEYx4mp0a31Kxh662WmMDAwHHrYqrUmm2jsNB4Jw0sWnR22wMSY9MPLdm17lQMQ_i9P-AHwEaMaI8E_I1z3tzUqi5IOC1YTxAWqGTsAC9wSWjHUoXdgUXRcYUL4MXif0kPxt4TzI3Dc0Fa0GLMF-H09ZRs31niVbdWXK7yKymW4CinBpSsivLOTGmEf1ZS2o5qyyj5M0Bc5paB3QQPvfV7Dr6FsF2EKsfqxtdo7r-Fyyn4I5hmqycClnrMtfQ9W7zo-gEOnxmRPX88T8PPbZX_-vVrdXF2fL1eVpk3DKi1UO3BE0aCxdYQZgrqOmsY6O2jOONWOGN2yzmBBGkFR63YPgmhtDCYNOQGf9r3bGH7NNmW58UnbsXzGhjlJ3CLKiSCYF6vYW3UsAKJ1chv9RsVniZHcwZcIy_5W_ocv_8CXjJXs2euYeShE_yX_0i6GL3vDUxgL2PQ4zk82yrVVY16_YcALCEOUYw</recordid><startdate>20140315</startdate><enddate>20140315</enddate><creator>DeVos, Jennifer M</creator><creator>Gaber, Ahmed Osama</creator><creator>Teeter, Larry D</creator><creator>Graviss, Edward A</creator><creator>Patel, Samir J</creator><creator>Land, Geoffrey A</creator><creator>Moore, Linda W</creator><creator>Knight, Richard J</creator><general>by Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140315</creationdate><title>Intermediate-Term Graft Loss After Renal Transplantation is Associated With Both Donor-Specific Antibody and Acute Rejection</title><author>DeVos, Jennifer M ; Gaber, Ahmed Osama ; Teeter, Larry D ; Graviss, Edward A ; Patel, Samir J ; Land, Geoffrey A ; Moore, Linda W ; Knight, Richard J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4226-c9a5b7040bc1ef36d30884d2efebc7674cf3dc568d19329405ff3dc93ccdd1323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Antibodies - blood</topic><topic>Antibodies - immunology</topic><topic>Black or African American</topic><topic>Black People</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - ethnology</topic><topic>Graft Rejection - immunology</topic><topic>Hispanic or Latino</topic><topic>HLA Antigens - immunology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Pancreas Transplantation</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Tissue Donors</topic><topic>Transplantation</topic><topic>White People</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DeVos, Jennifer M</creatorcontrib><creatorcontrib>Gaber, Ahmed Osama</creatorcontrib><creatorcontrib>Teeter, Larry D</creatorcontrib><creatorcontrib>Graviss, Edward A</creatorcontrib><creatorcontrib>Patel, Samir J</creatorcontrib><creatorcontrib>Land, Geoffrey A</creatorcontrib><creatorcontrib>Moore, Linda W</creatorcontrib><creatorcontrib>Knight, Richard J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DeVos, Jennifer M</au><au>Gaber, Ahmed Osama</au><au>Teeter, Larry D</au><au>Graviss, Edward A</au><au>Patel, Samir J</au><au>Land, Geoffrey A</au><au>Moore, Linda W</au><au>Knight, Richard J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intermediate-Term Graft Loss After Renal Transplantation is Associated With Both Donor-Specific Antibody and Acute Rejection</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2014-03-15</date><risdate>2014</risdate><volume>97</volume><issue>5</issue><spage>534</spage><epage>540</epage><pages>534-540</pages><issn>0041-1337</issn><issn>1534-6080</issn><eissn>1534-6080</eissn><abstract>BACKGROUNDRenal transplant recipients with de novo DSA (dDSA) experience higher rates of rejection and worse graft survival than dDSA-free recipients. This study presents a single-center review of dDSA monitoring in a large, multi-ethnic cohort of renal transplant recipients.
METHODSThe authors performed a nested case-control study of adult kidney and kidney-pancreas recipients from July 2007 through July 2011. Cases were defined as dDSA-positive whereas controls were all DSA-negative transplant recipients. DSA were determined at 1, 3, 6, 9, and 12 months posttransplant, and every 6 months thereafter.
RESULTSOf 503 recipients in the analysis, 24% developed a dDSA, of whom 73% had dDSA against DQ antigen. Median time to dDSA was 6.1 months (range 0.2–44.6 months). After multivariate analysis, African American race, kidney-pancreas recipient, and increasing numbers of human leukocyte antigen mismatches were independent risk factors for dDSA. Recipients with dDSA were more likely to suffer an acute rejection (AR) (35% vs. 10%, P<0.001), an antibody-mediated AR (16% vs. 0.3%, P<0.001), an AR ascribed to noncompliance (8% vs. 2%, P=0.001), and a recurrent AR (6% vs. 1%, P=0.002) than dDSA-negative recipients. At a median follow-up of 31 months, the death-censored actuarial graft survival of dDSA recipients was worse than the DSA-free cohort (P=0.002). Yet, for AR-free recipients, there was no difference in graft survival between cohorts (P=0.66).
CONCLUSIONSDevelopment of dDSA was associated with an increased incidence of graft loss, yet the detrimental effect of dDSA was limited in the intermediate term to recipients with AR.</abstract><cop>United States</cop><pub>by Lippincott Williams & Wilkins</pub><pmid>24595116</pmid><doi>10.1097/01.TP.0000438196.30790.66</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Antibodies - blood Antibodies - immunology Black or African American Black People Case-Control Studies Cohort Studies Female Follow-Up Studies Graft Rejection - epidemiology Graft Rejection - ethnology Graft Rejection - immunology Hispanic or Latino HLA Antigens - immunology Humans Incidence Kaplan-Meier Estimate Kidney Transplantation Male Middle Aged Multivariate Analysis Pancreas Transplantation Risk Factors Time Factors Tissue Donors Transplantation White People |
| title | Intermediate-Term Graft Loss After Renal Transplantation is Associated With Both Donor-Specific Antibody and Acute Rejection |
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