Posttransplant donor-specific anti-HLA antibodies negatively impact pancreas transplantation outcome

Am J Transplant. 2011 Dec;11(12):2737-46. doi: 10.1111/j.1600-6143.2011.03729.x. Epub 2011 Sep 11.

Abstract

During a 9-year follow-up, 167 consecutive pancreas transplant recipients (152 simultaneous pancreas-kidney [SPK]) were followed for the detection of posttransplant anti-HLA antibodies. Forty patients (24%) developed anti-HLA antibodies, 26 (65%) had donor-specific antibodies (DSA; 61% anticlass 2) and 14 (35%) non-DSA (78.6% anticlass 1). More rejection episodes were observed in patients with positive anti-HLA antibodies than in patients without antibodies (42.5% vs. 11%; p = 0.001), with the highest incidence observed in DSA patients (53.8%). More severe rejections (according to rescue therapy) were observed in DSA patients compared to non-DSA (p < 0.05) or to negative patients (p < 0.001). Contrasting with the kidney, pancreas graft survival did not differ between patients with or without anti-HLA antibodies. On the contrary, pancreas and kidney survivals were significantly lower in DSA positive patients (75% for both organs) as compared to non-DSA positive patients (100% for pancreas and 92% for kidney) or to HLA-negative patients (91% for pancreas and 89% for kidney). Nontechnical pancreas and kidney graft failures were significantly higher in positive than in negative anti-HLA patients (32.5% vs. 11%; p < 0.01). Occurrence of posttransplant DSA was an independent risk factor for both pancreas and kidney survival (HR 3.2; p = 0.039) in diabetic transplant recipients.

MeSH terms

  • Adult
  • Autoantibodies / blood*
  • Autoantibodies / immunology
  • Diabetes Mellitus / immunology
  • Diabetes Mellitus / mortality
  • Diabetes Mellitus / surgery
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Graft Rejection / blood*
  • Graft Rejection / immunology
  • Graft Rejection / mortality*
  • Graft Survival
  • HLA Antigens / immunology*
  • Histocompatibility Testing
  • Humans
  • Immunosuppression Therapy
  • Kidney Transplantation / immunology
  • Kidney Transplantation / mortality*
  • Male
  • Middle Aged
  • Pancreas Transplantation / immunology
  • Pancreas Transplantation / mortality*
  • Postoperative Complications*
  • Prospective Studies
  • Risk Factors
  • Survival Rate

Substances

  • Autoantibodies
  • HLA Antigens