학술논문
Donation type and the effect of pre-transplant donor specific antibodies – Data from the Swiss Transplant Cohort Study
Document Type
article
Author
Olivier de Rougemont; Yun Deng; Lukas Frischknecht; Caroline Wehmeier; Jean Villard; Sylvie Ferrari-Lacraz; Déla Golshayan; Monique Gannagé; Isabelle Binet; Urs Wirthmueller; Daniel Sidler; Thomas Schachtner; Stefan Schaub; Jakob Nilsson; the Swiss Transplant Cohort Study; Patrizia Amico; Andres Axel; John David Aubert; Vanessa Banz; Beckmann Sonja; Guido Beldi; Christoph Berger; Ekaterine Berishvili; Pierre-Yves Bochud; Sanda Branca; Heiner Bucher; Thierry Carrel; Emmanuelle Catana; Yves Chalandon; Sabina De Geest; Olivier De Rougemont; Michael Dickenmann; Joëlle Lynn Dreifuss; Michel Duchosal; Thomas Fehr; Nicola Franscini; Christian Garzoni; Paola Gasche Soccal; Christophe Gaudet; Nicolas Goossens; Karine Hadaya; Jörg Halter; Dominik Heim; Christoph Hess; Sven Hillinger; Hans Hirsch; Patricia Hirt; Günther Hofbauer; Uyen Huynh-Do; Franz Immer; Michael Koller; Mirjam Laager; Bettina Laesser; Roger Lehmann; Alexander Leichtle; Christian Lovis; Oriol Manuel; Hans-Peter Marti; Pierre Yves Martin; Michele Martinelli; Valérie McLin; Katell Mellac; Aurelia Mercay; Karin Mettler; Nicolas Mueller; Antonia Müller; Thomas Müller; Ulrike Müller-Arndt; Beat Müllhaupt; Mirjam Nägeli; Graziano Oldani; Manuel Pascual; Klara Posfay-Barbe; Juliane Rick; Anne Rosselet; Simona Rossi; Silvia Rothlin; Frank Ruschitzka; Urs Schanz; Aurelia Schnyder; Macé Schuurmans; Thierry Sengstag; Federico Simonetta; Katharina Staufer; Susanne Stampf; Jürg Steiger; Guido Stirniman; Ueli Stürzinger; Christian Van Delden; Jean-Pierre Venetz; Julien Vionnet; Madeleine Wick; Markus Wilhlem; Patrick Yerly
Source
Frontiers in Immunology, Vol 14 (2023)
Subject
Language
English
ISSN
1664-3224
Abstract
IntroductionThe type of donation may affect how susceptible a donor kidney is to injury from pre-existing alloimmunity. Many centers are, therefore, reluctant to perform donor specific antibody (DSA) positive transplantations in the setting of donation after circulatory death (DCD). There are, however, no large studies comparing the impact of pre-transplant DSA stratified on donation type in a cohort with a complete virtual cross-match and long-term follow-up of transplant outcome.MethodsWe investigated the effect of pre-transplant DSA on the risk of rejection, graft loss, and the rate of eGFR decline in 1282 donation after brain death (DBD) transplants and compared it to 130 (DCD) and 803 living donor (LD) transplants.ResultsThere was a significant worse outcome associated with pre-transplant DSA in all of the studied donation types. DSA directed against Class II HLA antigens as well as a high cumulative mean fluorescent intensity (MFI) of the detected DSA showed the strongest association with worse transplant outcome. We could not detect a significant additive negative effect of DSA in DCD transplantations in our cohort. Conversely, DSA positive DCD transplants appeared to have a slightly better outcome, possibly in part due to the lower mean fluorescent intensity (MFI) of the pre-transplant DSA. Indeed when DCD transplants were compared to DBD transplants with similar MFI (