Low levels of donor-specific antibodies increase risks for transplant recipients

Kidney transplant recipients who have even very low levels of preformed antibodies directed against a donated kidney have a significantly increased risk of organ rejection and kidney failure, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings could help clinicians provide better donor-recipient matches and tailor recipients' immunosuppressive therapy after transplantation.

Transplant recipients who have had previous transplants, blood transfusions, and other sensitizing events often have antibodies directed against a particular donor's kidney. These antibodies can increase the risk of and . But at what level do these antibodies put recipients at increased risk? Some newer tests, called solid phase assays, can detect them at much lower blood concentrations than traditional tests.

To investigate, Sumit Mohan, MD, Amudha Palanisamy, MD (Columbia University Medical Center) and their colleagues pored through the to find studies that looked at the of with such preformed donor-specific antibodies. Their search identified seven studies that included 1,119 patients.

Together, the results of these studies suggest that the detection of donor-specific antibodies by newer tests, despite negative results from older tests, nearly doubles the risk for antibody-mediated rejection and increases the risk of kidney failure by 76%. (The absolute risk of failure in the first year in the United States is currently about 8.2% for first-time recipients and about 10.7% for repeat transplant recipients.)

"Our study quantifies the level of risk associated with antibodies detected at the time of transplantation, helping clinicians better understand the prognosis and the risk of failure, thereby allowing for appropriate tailoring of immunosuppressive therapy," said Dr. Mohan. It also suggests that donor selection processes should take into consideration the presence of antibodies in the recipient, as identified by newer, more sensitive tests.

More information: The article, entitled "Donor-Specific Antibodies Adversely Impact Kidney Allograft Outcomes," will appear online on November 15, 2012, doi: 10.1681/2012070664

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Cold cash just keeps washing in from ALS challenge

Aug 28, 2014

In the couple of hours it took an official from the ALS Association to return a reporter's call for comment, the group's ubiquitous "ice bucket challenge" had brought in a few million more dollars.

Medtronic spends $350M on another European deal

Aug 27, 2014

U.S. medical device maker Medtronic is building stronger ties to Europe, a couple months after announcing a $42.9 billion acquisition that involves moving its main executive offices across the Atlantic, where it can get a ...

Mind over matter for people with disabilities

Aug 26, 2014

People with serious physical disabilities are unable to do the everyday things that most of us take for granted despite having the will – and the brainpower – to do so. This is changing thanks to European ...

User comments