Value of Donor–Specific Anti–HLA Antibody Monitoring And
CLINICAL RESEARCH www.jasn.org Value of Donor–Specific Anti–HLA Antibody Monitoring and Characterization for Risk Stratification of Kidney Allograft Loss † †‡ | Denis Viglietti,* Alexandre Loupy, Dewi Vernerey,§ Carol Bentlejewski, Clément Gosset,¶ † † †‡ Olivier Aubert, Jean-Paul Duong van Huyen,** Xavier Jouven, Christophe Legendre, † | † Denis Glotz,* Adriana Zeevi, and Carmen Lefaucheur* Departments of *Nephrology and Kidney Transplantation and ¶Pathology, Saint Louis Hospital and Departments of ‡Kidney Transplantation and **Pathology, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; †Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France; §Methodology Unit (EA 3181) CHRU de Besançon, France; and |University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania ABSTRACT The diagnosis system for allograft loss lacks accurate individual risk stratification on the basis of donor– specific anti–HLA antibody (anti-HLA DSA) characterization. We investigated whether systematic moni- toring of DSA with extensive characterization increases performance in predicting kidney allograft loss. This prospective study included 851 kidney recipients transplanted between 2008 and 2010 who were systematically screened for DSA at transplant, 1 and 2 years post-transplant, and the time of post– transplant clinical events. We assessed DSA characteristics and performed systematic allograft biopsies at the time of post–transplant serum evaluation. At transplant, 110 (12.9%) patients had DSAs; post- transplant screening identified 186 (21.9%) DSA-positive patients. Post–transplant DSA monitoring im- proved the prediction of allograft loss when added to a model that included traditional determinants of allograft loss (increase in c statisticfrom0.67;95%confidence interval [95% CI], 0.62 to 0.73 to 0.72; 95% CI, 0.67 to 0.77).
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