학술논문
Toward a sensible single antigen bead cut-off based on kidney graft survival
Document Type
Academic Journal
Author
Wisse, Bram W.; Kamburova, Elena G.; Joosten, Irma; Allebes, Wil A.; van der Meer, Arnold; Hilbrands, Luuk B.; Baas, Marije C.; Spierings, Eric; Hack, Cornelis E.; van Reekum, Franka E.; van Zuilen, Arjan D.; Verhaar, Marianne C.; Bots, Michiel L.; Drop, Adriaan C.A.D.; Plaisier, Loes; Seelen, Marc A.J.; Sanders, Jan Stephan; Hepkema, Bouke G.; Lambeck, Annechien J. A.; Bungener, Laura B.; Roozendaal, Caroline; Tilanus, Marcel G.J.; Voorter, Christien E.; Wieten, Lotte; van Duijnhoven, Elly M.; Gelens, Mariëlle A.C.J.; Christiaans, Maarten H.L.; van Ittersum, Frans J.; Nurmohamed, Shaikh A.; Lardy, Junior N.M.; Swelsen, Wendy; van der Pant, Karlijn A.M.I.; van der Weerd, Neelke C.; ten Berge, Ineke J.M.; Bemelman, Frederike J.; Hoitsma, Andries J.; van der Boog, Paul J.M.; de Fijter, Johan W.; Betjes, Michiel G.H.; Heidt, Sebastiaan; Roelen, Dave L.; Claas, Frans H.; Otten, Henny G.
Source
Transplantation. Aug 13, 2018
Subject
Language
English
ISSN
0041-1337
Abstract
BACKGROUND: There is no consensus in the literature on the interpretation of single antigen bead (SAB) positive for a specific HLA antibody. METHODS: To inform the debate, we studied the relationship between various SAB positivity algorithms and the impact of resulting donor-specific HLA antibody (DSA) positivity on long-term kidney graft survival in 3237 deceased-donor transplants. RESULTS: First, we showed that the interassay variability can be greatly reduced when working with signal-to-background ratios instead of absolute MFIs. Next, we determined pretransplant DSA using various MFI cut-offs, signal-to-background ratios (STBR) and combinations thereof. The impact of the various cut-offs was studied by comparing the graft survival between the DSA-positive and DSA-negative groups. We did not observe a strong impact of various cut-off levels on 10-year graft survival. A stronger relationship between the cut-off level and 1-year graft survival for DSA-positive transplants was found when using STBR, most pronounced for the bead of the same HLA-locus with lowest MFI taken as background. CONCLUSIONS: With respect to pretransplant risk stratification, we propose a SBTR-6 (using the bead of the same HLA-locus with lowest MFI as background) cut-off of 15 combined with an MFI cut-off of 500, resulting in 8% and 21% lower 1- and 10-years graft survival, respectively, for 8% DSA positive transplants.