Impact of the immunotherapy induction on allograft outcome and survival in kidney transplant patients with donor-specific antibodies to HLA-DQB1

Impact of the immunotherapy induction on allograft outcome and survival in kidney transplant patients with donor-specific antibodies to HLA-DQB1

The presence of donor-specific antibodies (DSAs) against HLA-DQB1 is considered a significant barrier to good outcome and allograft survival in kidney transplantation (KT). This study aimed to assess the impact of induction immunotherapy on the outcome and allograft survival in KT patients with HLA-...

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Bibliographic Details
Published in:Transplant immunology Vol. 66; p. 101390
Main Authors: Dutra, Rodrigo S., Fabreti-Oliveira, Raquel A., Lasmar, Marcus F., Araujo, Stanley A., Nascimento, Evaldo
Format: Journal Article
Language:English
Published: Netherlands Elsevier B.V 01-06-2021
Subjects:
Adult
Disease-Free Survival
Female
Follow-Up Studies
Graft rejection
Graft Rejection - immunology
Graft Rejection - mortality
Graft Rejection - prevention & control
Graft survival
Graft Survival - immunology
HLA-DQ beta-Chains - immunology
HLA-DQ-DSA
Humans
Immunotherapy
Isoantibodies - immunology
Kidney Transplantation
Male
Middle Aged
Outcome
rATG induction
Retrospective Studies
Survival Rate
HLA-DQ-DSA
Graft survival
rATG induction
Outcome
Kidney transplantation
Graft rejection
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Summary:The presence of donor-specific antibodies (DSAs) against HLA-DQB1 is considered a significant barrier to good outcome and allograft survival in kidney transplantation (KT). This study aimed to assess the impact of induction immunotherapy on the outcome and allograft survival in KT patients with HLA-DQB1-DSA. Thirty-two patients who had undergone KT and found to be positive for HLA-DQB1-DSA were monitored at least one to 10 years. They were allocated into two groups of patients: G1 received induction immunotherapy (n = 14 patients; 43.75%), and G2 did not (n = 18 patients; 56.25%). In G1, 6 (42.86%) patients experienced rejection episodes (RE), 2 (14.29%) due to antibody-mediated rejection (ABMR) and 4 (28.57%) due to T-cell-mediated rejection (TCMR). In G2, 13 (72.22%) patients experienced RE, 3 (16.67%) due to ABMR, and 10 (55.56%) due to TCMR. Graft loss occurred in 4 patients from G1, 2 (14.29%) due to ABMR and 2 (14.29%) due to non-immunological causes. In G2, 9 (50.00%) patients lost their grafts, 2 (11.11%) due to TCMR, 2 (11.11%) due to ABMR, and 5 (27.78%) due to non-immunological causes. The graft survival rate was 64.29% in G1 and 45.83% in G2. Glomerulitis and peritubular capillaritis were observed in 3 and C4d-positive patients with/or without induction who lost their grafts by ABMR by HLA-DQ DSA. Two patients from G2 lost their graft by TCMR due to interstitial lymphocytic infiltrate (i1), foci of mild tubulitis (t2), interstitial edema, moderate interstitial fibrosis and tubular atrophy. Better graft survival rates were shown in patients from G1 who received induction immunotherapy. Our study suggests that patients with an immunological profile of HLA-DQ+ DSA+ treated by immunotherapy induction have a decreased risk of ABMR and increased allograft survival, and the presence of anti-HLA-DQB1 DSA+ detected before and after KT were associated with ABMR episodes and failure.
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ISSN:0966-3274
1878-5492
DOI:10.1016/j.trim.2021.101390