Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies

Kwaku Marfo, Maria Ajaimy, Adriana Colovai, Liise Kayler, Stuart Greenstein, Michelle Lubetzky, Anjali Gupta, Layla Kamal, Graciela O. de Boccardo, Peter Masiakos, Milan Kinkhabwala, Enver Akalin

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Background: Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. Methods: Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. Results: Patients had a mean number of 1.6±0.8 DSAs with a mean fluorescence intensity value of 2,815±2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129±49 and 159±52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA-groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA-group were similar. Two DSA+ (3%) and five DSA-(2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4±0.6 mg/dL). Conclusion: Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSAj patients with pretransplantation immunologic risk assessment.

Original languageEnglish (US)
Pages (from-to)1082-1088
Number of pages7
Issue number10
StatePublished - 2014


  • Acute rejection
  • Donor-specific antibody
  • Intravenous immunoglobulin
  • Renal transplantation

ASJC Scopus subject areas

  • Transplantation
  • Medicine(all)


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