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Phillpott M, Daga S, Higgins R, Lowe D, Krishnan N, Zehnder D, Briggs D, Khovanova N. Dynamic Behaviour of Donor Specific Antibodies in the Early Period Following HLA Incompatible Kidney Transplantation. Transpl Int 2022; 35:10128. [PMID: 35516975 PMCID: PMC9062976 DOI: 10.3389/ti.2022.10128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022]
Abstract
In HLA-incompatible kidney transplantation, monitoring donor-specific antibodies (DSA) plays a crucial role in providing appropriate treatment and increases kidney survival times. This work aimed to determine if early post-transplant DSA dynamics inform graft outcome over and above other predictive factors. Eighty-eight cases were classified by unsupervised machine learning into five distinct DSA response groups: no response, fast modulation, slow modulation, rise to sustained and sustained. Fast modulation dynamics gave an 80% rate for early acute rejection, whereas the sustained group was associated with the lowest rejection rates (19%). In complete contrast, the five-year graft failure was lowest in the modulation groups (4–7%) and highest in the sustained groups (25–31%). Multivariable analysis showed that a higher pre-treatment DSA level, male gender and absence of early acute rejection were strongly associated with a sustained DSA response. The modulation group had excellent five-year outcomes despite higher rates of early rejection episodes. This work further develops an understanding of post-transplant DSA dynamics and their influence on graft survival following HLA-incompatible kidney transplantation.
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Affiliation(s)
- Mason Phillpott
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Sunil Daga
- St James's University Hospital, LTHT NHS Trust, Leeds, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, United Kingdom.,NIHR Leeds In-Vitro Diagnostics Co-operative, Leeds, United Kingdom
| | - Rob Higgins
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - David Lowe
- Histocompatibility and Immunogenetics, NHS Blood and Transplant, Birmingham, United Kingdom
| | - Nithya Krishnan
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Daniel Zehnder
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,North Cumbria Integrated Care NHS Trust, Carlisle, Cumbria, United Kingdom
| | - David Briggs
- Histocompatibility and Immunogenetics, NHS Blood and Transplant, Birmingham, United Kingdom.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Natalia Khovanova
- School of Engineering, University of Warwick, Coventry, United Kingdom
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