The Value of Protocol Biopsies to Identify Patients With De Novo Donor-Specific Antibody at High Risk for Allograft Loss

Abstract

De novo donor specific antibody (dnDSA) is associated with antibody mediated rejection (AMR) and allograft loss, yet the allograft histology associated with dnDSA remains unclear. The aim of this study was to examine the allograft histology associated with dnDSA in patients with serial surveillance biopsies. We retrospectively studied adult conventional solitary kidney transplant recipients from 10/2007–5/2014. DnDSA was new DSA with MFI >1000. The incidence of dnDSA was 7.0%(54/771) over mean follow-up of 4.2±1.9 years. Patients with dnDSA had reduced death-censored allograft survival (87.0% vs. 97.0% no dnDSA, p<0.01). 94% of patients received a biopsy after dnDSA (mean of 3 biopsies/patient). AMR was present in 25.0% and 52.9% of patients at dnDSA detection and at 1 year, respectively. Patients with both class I and II dnDSA had the highest rate of allograft loss. The higher the sum MFI at dnDSA detection, the higher the incidence of AMR. In conclusion, patients with dnDSA without AMR at time of detection may benefit from a follow-up biopsy within 1 year because AMR can be missed initially. Additionally, the dnDSA class and sum MFI at baseline appears to be prognostic. The higher the sum MFI of dnDSA at baseline, the higher the incidence of AMR.

Circulating de novo Donor Specific Antibodies and Carotid Intima-media Thickness in Pediatric Kidney Transplant Recipients, A Pilot Study

“…[P = 0.004] for early ACR, and 41.0% vs 7.0% [P < 0.0001] for late ACR, respectively). Liver fibrosis developed in 81.4% (72.1% mild [stage 1-2], 9.3% advanced [stage [3][4]) of LSBT children, compared to 79.5% (64.1% mild, 15.4% advanced) in LT (P = 0.6), after a median post-transplant follow-up of 2.2 years and 2.4 years, respectively.…”

De novo donor‐specific antibody following BK nephropathy: The incidence and association with antibody‐mediated rejection

“…The association between medication nonadherence and dnDSA has been well‐documented, but few studies have systematically examined the relationship between physician directed immunosuppression reduction for infectious disease reasons and subsequent development of dnDSA . A small cohort study of 19 patients with BK viremia showed that 79% developed de novo DSA with preemptive immunosuppression reduction .…”

“…27,28 Previous work has shown that features of antibody-mediated rejection (glomerulitis and peritubular capillaritis) in the setting of BK nephropathy are predictors of graft loss. 29 The association between medication nonadherence and dnDSA has been well-documented, 15,18,19,[30][31][32] but few studies have systematically examined the relationship between physician directed immunosuppression reduction for infectious disease reasons and subsequent development of dnDSA. 33 immunosuppression reduction.…”

The role of complement‐fixing donor‐specific antibodies identified by a C1q assay after heart transplantation

“… Recipients with post‐transplant DSA: recipients showing post‐transplant DSA, either de novo DSA or pre‐transplant DSA that were maintained after transplant. The definition of de novo DSA was any DSA identified at least a week after transplant that was absent at any time prior to transplant (each recipient had at least one pre‐transplant SAB test) Recipients with no post‐transplant DSA: recipients who did not show DSA pre‐transplant or in any of the post‐transplant studies. …”