Impact of alloantibody strength in crossmatch negative DSA positive kidney transplantation

Abstract Objectives The clinical relevance of pre-transplant “low-level” donor specific anti-HLA antibodies (DSAs) in crossmatch negative kidney transplant recipients remains unclear. To determine what level of DSA associates with antibody mediated rejection (AMR) could be the way to measure the clinical relevance of pre-transplant “low-level” donor specific anti-HLA antibodies (DSAs) in crossmatch negative kidney transplant recipients. Design and methods A retrospective analysis of 221 patients from October 2008 to December 2009 was included in this study. Sera were obtained pre-transplant and two weeks post-transplant and tested for DSA using LABScreen single antigen beads. Results Among the 221 patients, 11 experienced AMR within 200 days after transplant (5%). Pre-transplant DSA was associated with AMR at multiple mean fluorescence intensity (MFI) cutoffs (500, 1000, 2000, 3000, 5000; p = 0.003, 0.001, 0.007, 0.003, and 0.003, respectively). No correlation was seen between acute T-cell mediated rejection (CMR) and pre-transplant DSA at any of the same MFI cutoffs. There was an increased risk of AMR with higher levels of pre-transplant DSA. Finally, an increase in DSA MFI from pre- to two weeks post-transplant was indicative of a higher probability of AMR. Conclusion Overall, this data supports using the single antigen bead to detect “low-level” DSA both pre- and post- as having a positive and persistent DSA may be predictive of higher AMR rates and poorer graft survival.