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Published on: August 12, 2017
Complement Binding Anti-HLA Antibodies and the Survival of Kidney Transplantation
Claudia M Muñoz-Herrera1,2,3,4, Juan Francisco Gutiérrez-Bautista1,3,5, Miguel Ángel López-Nevot1,3,5
1Departamento de Bioquímica, Biología Molecular e Inmunología III, University of Granada, 18010 Granada, Spain.
Insights
Complement-fixing de novo donor-specific antibodies (dnDSA) are linked to kidney transplant rejection and graft loss. Detecting dnDSA complement-binding capacity may predict transplant outcomes.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Antibody-mediated rejection (AMR) poses a significant challenge in renal transplantation.
- Donor-specific antibodies (dnDSA) binding to the kidney graft activate complement, leading to transplant loss.
- Understanding dnDSA characteristics is crucial for improving graft survival.
Purpose of the Study:
- To evaluate the association between complement-fixing dnDSA and graft loss.
- To assess the relationship between non-complement-fixing dnDSA and transplanted organ survival.
Main Methods:
- A cohort of 245 kidney transplant recipients was studied over 5 years.
- Patients were monitored for the presence and type of de novo donor-specific antibodies (dnDSA).
Main Results:
- De novo donor-specific antibodies (dnDSA) were detected in 26 patients.
- Of these, 17 had non-complement-fixing dnDSA and 9 had complement-fixing dnDSA.
- A significant association was found between C1q-binding dnDSA and renal graft loss.
Conclusions:
- The presence of C1q-binding dnDSA is significantly associated with kidney transplant rejection and graft loss.
- Classifying dnDSA based on complement-activating capacity is important for predicting AMR outcomes.
- Detecting dnDSA complement-binding capacity can serve as a prognostic marker for graft survival in kidney transplant recipients.
Background:
Antibody-mediated rejection (AMR) is one of the most important challenges in the context of renal transplantation, because the binding of de novo donor-specific antibodies (dnDSA) to the kidney graft triggers the activation of the complement, which in turn leads to loss of transplant. In this context, the objective of this study was to evaluate the association between complement-fixing dnDSA antibodies and graft loss as well as the possible association between non-complement-fixing antibodies and transplanted organ survival in kidney transplant recipients.
Methods:
Our study included a cohort of 245 transplant patients over a 5-year period at Virgen de las Nieves University Hospital (HUVN) in Granada, Spain.
Results:
dnDSA was observed in 26 patients. Of these patients, 17 had non-complement-fixing dnDSA and 9 had complement-fixing dnDSA.
Conclusions:
Our study demonstrated a significant association between the frequency of rejection and renal graft loss and the presence of C1q-binding dnDSA. Our results show the importance of the individualization of dnDSA, classifying them according to their ability to activate the complement, and suggest that the detection of complement-binding capacity by dnDSA could be used as a prognostic marker to predict AMR outcome and graft survival in kidney transplant patients who develop dnDSA.
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