Preformed Donor-Specific Antibodies in Kidney Transplant: A Center Experience

The presence of preformed donor-specific alloantibodies (DSAs) at the time of transplantation has been associated with an increased risk of rejection, dysfunction, and shorter survival. Detection and identification of these antibodies have improved with more sensitive assays, but their clinical relevance and influence on long-term outcomes are unclear.

We investigate the impact of pretransplant DSAs on the outcomes of kidney transplantation. A retrospective analysis was conducted on all patients who received a deceased donor kidney transplant in our center between January 2017 and December 2021. The study population consisted of 75 kidney transplantations, and DSAs were detected in 15 patients (20%) before transplantation.

There was no significant difference in delayed graft function, serum creatinine level at discharge and the first year after transplant, acute rejection rates, or graft survival in patients with and without preformed DSAs.

Detecting pretransplant DSAs by highly sensitive assays may not necessarily impact long-term graft outcomes, and the mismatch should be individually evaluated.