De novo donor specific antibody affect the prognosis of kidney transplant recipients: retrospective study

Objective To explore the relationship between positive rate of de novo donor specific antibody (dnDSA) and human leukocyte antigen (HLA) mismatch after kidney transplantation and explore the impact of dnDSA upon long-term graft survival and rejection. Methods Retrospective analysis was conducted for clinical data of 101 kidney transplant recipients. Based upon HLA antibody and dnDSA, they were divided into three groups of HLA- (n=70), dnDSA- (n=23) and dnDSA+ (n=8). Rejection and graft survival were recorded for evaluating the impact of dnDSA on rejection and graft survival and observing the differences among all groups. Results The mismatchs of HLA-A/B and HLA-DR were more frequent than HLA- and dnDSA- groups(P=0.047, P=0.010)and graft survival was lower in dnDSA+ group than HLA- and dnDSA- groups (P=0.001). The rejection rate was higher in dnDSA+ group (62.5%) than HLA- group (8.57%) and dnDSA- group (8.69%). The difference was statistically significant (P=0.013). Pathological examination indicated microcirculatory inflammation (glomerulonephritis & trichodangiitis) and damage (multilayer change of capillary basement membrane) occurred frequently in dnDSA+ group and C4d remained positive. However, scar, arterial fibrosis or tubulointerstitial inflammation was not correlated with dnDSA. Conclusions HLA mismatch is correlated with dnDSA positivity. And dnDSA may reduce graft survival and enhance rejection rate. Rejection mediated by dnDSA is often accompanied by microcirculatory inflammation and C4d positivity. Key words: Kidney transplantation; Donor specific antibody; Rejection; Graft Survival