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Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study

Caroline Wehmeier, Patrizia Amico, Daniel Sidler, Urs Wirthmüller, Karine Hadaya, Sylvie Ferrari-Lacraz, Dela Golshayan, Vincent Aubert, Aurelia Schnyder, Kata Sunic, Thomas Schachtner, Jakob Nilsson, Stefan Schaub & Swiss Transplant Cohort Study

abstract The aim of this study was to analyze first year renal outcomes in a nationwide prospective multicenter cohort comprising 2215 renal transplants, with a special emphasis on the presence of pre-transplant donor-specific HLA antibodies (DSA). All transplants had a complete virtual crossmatch and DSA were detected in 19% (411/2215). The investigated composite endpoint was a poor first-year outcome defined as (i) allograft failure or (ii) death or (iii) poor allograft function (eGFR ≤25 ml/min/1.73 m ) at one year. Two hundred and twenty-one (221/2215; 10%) transplants showed a poor first-year outcome. Rejection (24/70; 34%) was the most common reason for graft failure. First-year patient's death was rare (48/2215; 2%). There were no statistically significant differences between DSA-positive and DSA-negative transplants regarding composite and each individual endpoint, as well as reasons for graft failure and death. DSA-positive transplants experienced more frequently rejection episodes, mainly antibody-mediated rejection (both P < 0.0001). The combination of DSA and any first year rejection was associated with the overall poorest death-censored allograft survival (P < 0.0001). In conclusion, presence of pre-transplant DSA per se does not affect first year outcomes. However, DSA-positive transplants experiencing first year rejection are a high-risk population for poor allograft survival and may benefit from intense clinical surveillance.
   
citation Wehmeier C, Amico P, Sidler D, Wirthmüller U, Hadaya K, Ferrari-Lacraz S, Golshayan D, Aubert V, Schnyder A, Sunic K, Schachtner T, Nilsson J, Schaub S, Swiss Transplant Cohort Study . Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study. Transpl Int 2021; 34:2755-2768.
   
type journal paper/review (English)
date of publishing 13-10-2021
journal title Transpl Int (34/12)
ISSN electronic 1432-2277
pages 2755-2768
PubMed 34561920
DOI 10.1111/tri.14119