The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical significance of the presence of anti-human leukocyte antigen-donor specific antibody in kidney transplant recipients with allograft dysfunction

  • Chung, Byung Ha (Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Jeong Ho (Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Choi, Bum Soon (Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Park, Cheol Whee (Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Ji-Il (Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Moon, In Sung (Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Yong-Soo (Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Choi, Yeong Jin (Department of Hospital Pathology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Oh, Eun-Jee (Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Yang, Chul Woo (Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2016.03.30
  • Accepted : 2016.05.28
  • Published : 2018.01.01
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Abstract

Background/Aims: This study investigated the clinical significance of detecting anti-human leukocyte antigen-donor specific antibody (HLA-DSA) in kidney transplant recipients (KTRs) requiring indication biopsy owing to allograft dysfunction. Methods: We analyzed the presence of HLA-DSA in 210 KTRs who took indication biopsy. We divided these cases into two groups, HLA-DSA (+) (n = 52) and HLA-DSA (-) (n = 158) group, and compared the clinical characteristics, pathological findings, and clinical outcomes of the two groups. Results: The rates of retransplant, pretransplant sensitization, and HLA-mismatch were significantly higher in HLA-DSA (+) group than in HLA-DSA (-) group (p < 0.05 for each comparison). In histologic finding, all types of rejections were more frequent in the former group. Besides, scores of both the T-cell injury markers such as tubulitis, interstitial inf lammation, and vasculitis and antibody-mediated injury markers such as peritubular C4d deposition and microvascular inflammation (glomerulitis plus peritubular capillaritis) were higher in HLA-DSA (+) group (p < 0.05 for each). Notably, allograft outcomes were worse in HLA-DSA (+) group. Further, multivariate analysis showed that presence of HLA-DSA, advanced interstitial fibrosis/tubular atrophy (interstitial fibrosis plus tubular atrophy ${\geq}2$), and allograft rejection in biopsy were independent risk factors for allograft failure. Conclusions: The results of this study showed that presence of HLA-DSA in a case of allograft dysfunction adversely influences allograft outcome, and its detection, irrespective of the result of the allograft biopsy, necessitates intensive monitoring and treatment.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

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