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Korean J Transplant 2021; 35(1): 33-40

Published online March 31, 2021

https://doi.org/10.4285/kjt.20.0052

© The Korean Society for Transplantation

Clinical significance of de novo donor-specific antibody in kidney transplant recipients with chronic antibody-mediated rejection

Woo Yeong Park1,2 , Yaerim Kim1,2 , Jin Hyuk Paek1,2 , Kyubok Jin1,2 , Seungyeup Han1,2

1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
2Keimyung University Kidney Institute, Daegu, Korea

Correspondence to: Seungyeup Han
Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine and Keimyung University Kidney Institute, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea
Tel: +82-53-258-7712
Fax: +82-53-258-4739
E-mail: hansy@dsmc.or.kr

Received: October 27, 2020; Revised: December 14, 2020; Accepted: December 15, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Chronic antibody-mediated rejection (CABMR) is an important cause of late graft loss. De novo donor-specific antibody (dnDSA) is an important prognostic factor for long-term allograft outcomes. However, the prognosis of CABMR based on the presence of dnDSA is uncertain.
Methods: We retrospectively analyzed 35 kidney transplant recipients with CABMR between 2010 and 2018. Fourteen recipients had no detectable DSA, and 21 recipients had detectable DSA. We investigated the pathologic findings at diagnosis of CABMR, allograft function 12 months later, related factors for allograft failure, and allograft survival rate based on the presence of dnDSA.
Results: The pathologic findings showed that acute and chronic changes were more severe in the dnDSA (+) group than in the dnDSA (–) group. There was no significant difference in the allograft function 12 months after the diagnosis of CABMR and in the amount of proteinuria at diagnosis between the two groups. However, the death-censored graft survival rate was lower in the high-proteinuria group than in the low-proteinuria group in both groups. The treatment rate of recipients was higher in the dnDSA (+) group than in the dnDSA (–) group; however, there was no significant difference in the death-censored graft survival rate between the two groups.
Conclusions: Although the effect of dnDSA on the prognosis of CABMR is not clear, it would be important not to neglect treatment for CABMR with risk factors for allograft failure even without dnDSA. Continuous and rigorous surveillance of DSA and allograft function is needed in patients with CABMR.

Keywords: Kidney transplantation, Graft rejection, Antibodies, Risk factor, Treatment

HIGHLIGHTS
  • We investigated the clinical outcomes of chronic antibody-mediated rejection (CABMR) based on the presence of de novo donor-specific antibody (dnDSA).

  • Pathologic findings showed that acute and chronic change was more severe in the dnDSA (+) group than in the dnDSA (–) group.

  • The treatment rate of recipients was higher in the dnDSA (+) group than in the dnDSA (–) group, but, there was no difference of prognosis between the two groups.

  • Continuous and rigorous surveillance of DSA and allograft function is needed in patients with CABMR.