Utility of Routine Post Kidney Transplant Anti-HLA Antibody Screening

Area of Science:

• Nephrology
• Transplant Immunology
• Clinical Diagnostics

Background:

• De novo donor-specific antibodies (dnDSA) are key indicators of antibody-mediated rejection (AMR) and graft loss in kidney transplantation.
• Despite high costs, systematic annual dnDSA screening is recommended by some agencies, but its clinical utility remains uncertain.

Purpose of the Study:

• To evaluate the incidence and clinical utility of dnDSA detection through systematic screening versus clinically indicated testing in low-immunological risk kidney transplant recipients.

Main Methods:

• Retrospective analysis of 1072 kidney transplant patients (low-risk: non-HLA sensitized, no prior transplant).
• Assessed dnDSA incidence based on test justification (systematic vs. clinically indicated).
• Follow-up period of 8 years (IQR: 5-11) with 4611 anti-HLA tests.

Main Results:

• dnDSA developed in 7.2% of patients; 45.5% were detected within the first year.
• Systematic screening detected dnDSA in only 1.08% of tests.
• Active and chronic AMR were frequent in biopsies following systematic DSA testing (17.9% and 15.4%).

Conclusions:

• Systematic dnDSA screening in low-risk kidney transplant patients infrequently identifies dnDSA, particularly after the first year.
• Clinically indicated testing appears more effective for early AMR detection than routine annual screening in this population.