Journal article
C1q Donor-Specific Antibody Associates with Post-transplant Biopsy Findings in Highly- Sensitized Kidney Transplant Recipients
Clinical transplants, Vol.32, pp.127-134
2016
PMID: 28564530
Abstract
Donor-specific anti-human leukocyte antigen antibodies (DSA) are associated with antibody-mediated rejection (AMR) in kidney transplantation, but the spectrum of graft injury seen in patients with DSA ranges from no damage to florid rejection. Since immunoglobulin G (IgG) antibodies with cytotoxic potential can be distinguished by their binding complement fraction C1q, the level of C1q-binding IgG (C1q+) DSA may be useful for stratifying risk or diagnosing AMR. We therefore investigated the value of IgG and C1q+ DSA in predicting pathologic features of AMR on kidney biopsies. We tested the associations between DSA at different cut-off levels and pathologic features of AMR on biopsy in a cohort of consecutive, highly-sensitized patients transplanted after December 2014 who had 1-, 3-, and 6-month protocol kidney biopsies and monitoring for IgG and C1q+ DSA. Eight patients with cPRA >90% and negative flow crossmatch underwent kidney transplant and completed six months of follow-up contributing 23 pairs of biopsy/ serum samples for analysis. C1q+ DSA was significantly associated with C4d finding on biopsy at mean fluorescence intensity (MFI) cut-offs of >100 (p=0.046) and >300 (p=0.008) and showed superior positive and negative predictive value in comparison to conventional IgG DSA. C1q+ DSA also showed significant association and good predictive value for any AMR feature on biopsy (p=0.003, for >100 MFI; p=0.005 for >300 MFI), while IgG DSA showed no association. In a small cohort of high cPRA transplant recipients, C1q+ DSA outperformed IgG DSA as an indicator of AMR biopsy findings. Including C1q+ DSA testing in post-transplant DSA monitoring of highly-sensitized patients may aid the timely diagnosis of AMR.
Details
- Title: Subtitle
- C1q Donor-Specific Antibody Associates with Post-transplant Biopsy Findings in Highly- Sensitized Kidney Transplant Recipients
- Creators
- Sarat Kuppachi - Division of Nephrology, Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IADanniele Holanda - Department of Pathology, The University of Iowa Carver College of Medicine, Iowa City, IASara Gallegos - Iowa Regional Histocompatibility and Immunogenetics Laboratory, Iowa City VA Health Care System, Iowa City, IAElizabeth H Field - Division of Immunology, Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Clinical transplants, Vol.32, pp.127-134
- Publisher
- United States
- PMID
- 28564530
- ISSN
- 0890-9016
- Language
- English
- Date published
- 2016
- Academic Unit
- Stead Family Department of Pediatrics; Pathology; Nephrology; Immunology; Internal Medicine
- Record Identifier
- 9984047896602771
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