Risk Stratification Before Living Donor Kidney Transplantation in Patients With Preformed Donor-specific Antibodies by Different Crossmatch Methods

Malte Ziemann, MD; Monika Lindemann, MD; Michael Hallensleben, MD; Wolfgang Altermann, MD; Karina Althaus, MD; Klemens Budde, MD; Gunilla Einecke, MD; Ute Eisenberger, MD; Andrea Ender, PhD; Thorsten Feldkamp, MD; Florian Grahammer, MD; Martina Guthoff, MD; Christopher Holzmann-Littig, MD; Christian Hugo, MD; Teresa Kauke, MD; Stephan Kemmner, MD; Martina Koch, MD; Nils Lachmann, PhD; Matthias Marget, PhD; Christian Morath, MD; Martin Nitschke, MD; Lutz Renders, MD; Sabine Scherer, MD; Julian Stumpf, MD; Vedat Schwenger, MD; Florian Sommer, MD; Bernd Spriewald, MD; Caner Süsal, MD; Daniel Zecher, MD; Falko M. Heinemann, PhD; Murielle Verboom, PhD

doi:10.1097/TXD.0000000000001680

Transplantation Direct (Sep 2024)

Risk Stratification Before Living Donor Kidney Transplantation in Patients With Preformed Donor-specific Antibodies by Different Crossmatch Methods

Malte Ziemann, MD,
Monika Lindemann, MD,
Michael Hallensleben, MD,
Wolfgang Altermann, MD,
Karina Althaus, MD,
Klemens Budde, MD,
Gunilla Einecke, MD,
Ute Eisenberger, MD,
Andrea Ender, PhD,
Thorsten Feldkamp, MD,
Florian Grahammer, MD,
Martina Guthoff, MD,
Christopher Holzmann-Littig, MD,
Christian Hugo, MD,
Teresa Kauke, MD,
Stephan Kemmner, MD,
Martina Koch, MD,
Nils Lachmann, PhD,
Matthias Marget, PhD,
Christian Morath, MD,
Martin Nitschke, MD,
Lutz Renders, MD,
Sabine Scherer, MD,
Julian Stumpf, MD,
Vedat Schwenger, MD,
Florian Sommer, MD,
Bernd Spriewald, MD,
Caner Süsal, MD,
Daniel Zecher, MD,
Falko M. Heinemann, PhD,
Murielle Verboom, PhD

Affiliations

Malte Ziemann, MD: 1 Institute for Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany.
Monika Lindemann, MD: 2 Institute for Transfusion Medicine, University Hospital Essen, Essen, Germany.
Michael Hallensleben, MD: 3 Institute for Transfusion Medicine, Medizinische Hochschule Hannover, Hannover, Germany.
Wolfgang Altermann, MD: 4 Institute for Transfusion Medicine, University Hospital Halle, Halle, Germany.
Karina Althaus, MD: 5 Institute for Clinical and Experimental Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany.
Klemens Budde, MD: 7 Medizinische Klinik m. S. Nephrologie, Charité–Universitätsmedizin Berlin, Berlin, Germany.
Gunilla Einecke, MD: 8 Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Hannover, Germany.
Ute Eisenberger, MD: 9 Klinik für Nephrologie, University Hospital Essen, Essen, Germany.
Andrea Ender, PhD: 10 Institute for Transfusion Medicine, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany.
Thorsten Feldkamp, MD: 11 Transplant Center, University Hospital of Schleswig-Holstein, Kiel, Germany.
Florian Grahammer, MD: 12 III. Medizinische Klinik und Poliklinik für Nephrologie, Rheumatologie und Endokrinologie, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Martina Guthoff, MD: 14 Medizinische Klinik IV, Sektion Nieren- und Hochdruckkrankheiten, University Hospital Tübingen, Tübingen, Germany.
Christopher Holzmann-Littig, MD: 15 Nephrologie, Klinikum Rechts der Isar, Technische Universität München, München, Germany.
Christian Hugo, MD: 16 Medizinische Klinik III, University Hospital Carl Gustav Carus, Dresden, Germany.
Teresa Kauke, MD: 17 Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Labor für Immungenetik, Klinik für Anästhesiologie, Klinikum der Universität München, München, Germany.
Stephan Kemmner, MD: 19 Transplant Center, Klinikum der Universität München, München, Germany.
Martina Koch, MD: 20 Hepatobiliäre Chirurgie und Transplantationschirurgie, University Hospital Hamburg, Hamburg, Germany.
Nils Lachmann, PhD: 21 HLA-Labor, Charité–Universitätsmedizin Berlin, Berlin, Germany.
Matthias Marget, PhD: 22 Institute for Transfusion Medicine, University Hospital Hamburg, Hamburg, Germany.
Christian Morath, MD: 23 Zentrum für Innere Medizin, Nephrologie, University Hospital Heidelberg, Heidelberg, Germany.
Martin Nitschke, MD: 24 Transplant Center, University Hospital of Schleswig-Holstein, Lübeck, Germany.
Lutz Renders, MD: 15 Nephrologie, Klinikum Rechts der Isar, Technische Universität München, München, Germany.
Sabine Scherer, MD: 25 Institut für Immunologie, Transplantationsimmunologie, University Hospital Heidelberg, Heidelberg, Germany.
Julian Stumpf, MD: 16 Medizinische Klinik III, University Hospital Carl Gustav Carus, Dresden, Germany.
Vedat Schwenger, MD: 26 Klinik für Nieren-, Hochdruck- und Autoimmunerkrankungen, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany.
Florian Sommer, MD: 27 Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, University Hospital Augsburg, Augsburg, Germany.
Bernd Spriewald, MD: 28 Medizinische Klinik 5–Hämatologie und Internistische Onkologie, University Hospital Erlangen, Erlangen, Germany.
Caner Süsal, MD: 25 Institut für Immunologie, Transplantationsimmunologie, University Hospital Heidelberg, Heidelberg, Germany.
Daniel Zecher, MD: 29 Department of Nephrology, University Hospital Regensburg, Regensburg, Germany.
Falko M. Heinemann, PhD: 2 Institute for Transfusion Medicine, University Hospital Essen, Essen, Germany.
Murielle Verboom, PhD: 3 Institute for Transfusion Medicine, Medizinische Hochschule Hannover, Hannover, Germany.

DOI: https://doi.org/10.1097/TXD.0000000000001680
Journal volume & issue: Vol. 10, no. 9
p. e1680

Abstract

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Background. Preformed donor-specific HLA antibodies (DSA) are a well-known risk factor in kidney transplantation. There is still considerable debate, however, about the optimal risk stratification among patients with preformed DSA. Additionally, data on the prognostic value of different crossmatch assays in DSA-positive patients are scarce. Methods. DSA-positive living kidney transplant recipients were selected from a multicenter study examining 4233 consecutive renal transplants. An additional 7 patients from 2 further centers were included. Flow cytometric crossmatches (FXM), Luminex-based crossmatches, and virtual crossmatches based on C1q- and C3d-binding antibodies (C1qXM and C3dXM) were performed retrospectively using pretransplant sera and lymphocytes isolated from fresh samples. These samples were obtained from 44 donor and recipient pairs from 12 centers. Clinical outcome data and the control group without DSA were compiled from the previous study and were supplemented by data on 10-y death-censored graft survival (10yGS). Results. Between 19% (C3dXM) and 46% (FXM) of crossmatches were positive. Crossmatch-positive patients showed high incidences of antibody-mediated rejection (AMR) within 6 mo (up to 60% in B-cell FXM+ patients). The incidence of AMR in crossmatch-negative patients ranged between 5% (FXM−) and 13% (C1qXM−). 10yGS was significantly impaired in patients with positive T-cell FXM and total FXM compared with both patients without DSA and those with DSA with negative FXM. Conclusions. Especially FXM are useful for risk stratification, as the outcome of DSA-positive, FXM-negative patients is similar to that of DSA-negative patients, whereas FXM-positive patients have both more AMR and decreased 10yGS. Because of their lower sensitivity, the significance of Luminex-based crossmatches, C1qXM, and C3dXM would have to be examined in patients with stronger DSA.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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