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Published on: May 2, 2013
Utility of Routine Post Kidney Transplant Anti-HLA Antibody Screening
Sofiane Salhi1,2, Nicolas Congy-Jolivet2,3,4, Anne-Laure Hebral1
1Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
Insights
Systematic screening for de novo donor-specific antibodies (dnDSA) rarely detects these in low-risk kidney transplant patients after the first year. Clinically indicated testing appears more impactful for early antibody-mediated rejection (AMR) detection than routine annual 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.
Introduction:
De novo donor-specific antibody (dnDSA) is a strong biomarker associated with the development of antibody-mediated rejection (AMR) and graft loss after kidney transplantation. This procedure is expensive; however, systematic annual screening was recommended by some national organ transplant agencies or societies even though its clinical utility was not clearly established.
Methods:
To address this question, we retrospectively assessed the incidence of dnDSA according to the test justification (clinically indicated or systematic) in a cohort of low-immunological risk patients, defined by being nonhuman leukocyte antigen (non-HLA)-sensitized and having no previous kidney transplants.
Results:
A total of 1072 patients, for whom 4611 anti-HLA tests were performed, were included in the study. During the follow-up period of 8 (interquartile range, IQR: 5-11) years, 77 recipients developed dnDSA (prevalence of 7.2%). Thirty-five of these dnDSAs (45.5%) were detected during the first year posttransplantation. In 95% of patients with dnDSA, an immunizing event was identified in their medical records. dnDSA was detected in 46 of 4267 systematic screening tests (1.08%) performed. Active and chronic AMR were frequently observed in biopsies performed after systematic DSA testing (17.9% and 15.4%, respectively).
Conclusion:
Our results suggest that the detection by systematic screening of dnDSA in low-immunological risk kidney transplant patients without sensitizing events is a rare event, especially after 1 year. Moreover, in real life, systematic annual screening for dnDSA, seems having a limited impact to detect AMR at an earlier stage compared to patients in whom dnDSA was detected after a clinically indicated test.
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