Effect of C1q-binding donor-specific anti-HLA antibodies on the clinical outcomes of patients after renal transplantation: A systematic review and meta-analysis |
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| Affiliation: | 1. Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland;2. Polish Transplant Coordinating Center “Poltransplant,” Warsaw, Poland;3. Department of Transplant Medicine, Nephrology, and Internal Diseases, Warsaw Medical University, Warsaw, Poland;4. Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland;1. Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;2. Department of Immunology, Transplantology and Internal Medicine, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;3. Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;1. Department of Cardiac Surgery and Vascular Surgery, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland;2. Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland;3. Immunology & Transplantology Clinical Laboratory, University Laboratory Medicine Centre, University Clinical Center in Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;4. Department of Histology, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052 Opole, Poland;5. Medical University of Gdansk (student), M. Sklodowskiej-Curie 3a, 80-210 Gdańsk, Poland;6. Department of Gastroenterology and Hepatology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland;7. Department of Pneumonology and Allergology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland;1. Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, IL, United States of America;2. Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America;3. Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America;4. Heart and Vascular Institute, Section of Cardiology, Lewis Katz School of Medicine, Philadelphia, PA, United States of America;5. Division of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States of America;6. Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America;1. Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon;2. Department of Surgery, Middle East Institute of Health, Bsalim, Lebanon;3. Department of Surgery, Saint-George Hospital-UMC, Beirut, Lebanon;4. Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Sector of Public Health and Epidemiology, Department of Public Health, Beirut, Lebanon;5. Department of Nephrology, Middle East Institute of Health, Bsalim, Lebanon |
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| Abstract: | BackgroundComplement-binding donor-specific human leukocyte antigen (HLA) antibodies in kidney recipients have been associated with a higher risk of allograft rejection and loss. The objective of this meta-analysis was to investigate the correlation between C1q-binding donor-specific antibodies (DSAs) and clinical outcomes in kidney transplantation (KT) recipients.MethodsWe conducted systematic searches in the PubMed, EMBASE, and the Cochrane Library databases to identify all studies since inception to August 2021 that compared clinical outcomes between C1q + DSA and C1q-DSA patients who underwent KT. Data were independently extracted by two reviewers who assessed the risk of bias. Data were summarized with fixed effects or random effects models according to heterogeneity. We assessed clinical outcomes including graft loss, rejection, delayed graft function (DGF), and all-cause patient death.ResultsTwenty-six studies with a total of 1337 patients were included: 485 with C1q-binding DSAs, and 850 without C1q-binding DSAs. Compared with the C1q-DSA group, the C1q + DSA group had significant increases in antibody-mediated rejection (AMR) (relative risk [RR] = 2.09, 95% confidence interval [CI], 1.53–2.86; P < 0.00001), graft loss (RR = 2.40, 95% CI, 1.66–3.47; P < 0.00001), and death (RR = 3.13, 95% CI, 1.06–9.23; P = 0.04). The C1q + DSA and C1q-DSA groups did not show significant differences in T-cell-mediated rejection, acute rejection, acute cellular rejection, mixed rejection, or DGF.ConclusionThe findings of this systematic review suggest that C1q + DSA KT have a higher risk of AMR, graft loss, and death compared with C1q-DSA patients. Monitoring C1q-binding DSAs allows risk stratification of recipients and guides physician management. |
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