Flashback to 2002: a retesting and reanalysis suggests an important role of DSA

In 2002, Lee et al. published the first paper describing the effect of HLA antibodies on graft failure in kidney transplant patients, yet remained skeptical as to why some patient grafts were surviving years longer than others while testing positive for HLA antibodies. Through a retesting and reanalysis of these patient samples, we confirm the effect that HLA antibodies had on graft failure. Furthermore, our data suggests an explanation for the discrepancy in patient graft survival lasting significant periods of time with HLA antibodies. Through use of updated technology by Luminex testing, as opposed to the ELISA-based HLA screening used in 2002, we confirm that although patient grafts are surviving significant periods of time with HLA antibodies, these antibodiesare not DSA. Thus, grafts with non-DSA HLA antibodies are able to survive longer than grafts with DSA. The data also proposes that lower DSA MFI values are less detrimental to graft survival as well. Moreover, the recent data also suggests that Class I DSA leads to an even shorter graft survival than Class II only DSA.