Impaired graft survival in pediatric renal transplant recipients with donor‐specific antibodies detected by solid‐phase assays

Verghese PS, Smith JM, McDonald RA, Schwartz SM, Nelson KA, Warner PR. Impaired graft survival in pediatric renal transplant recipients with donor‐specific antibodies detected by solid‐phase assays. Pediatr Transplantation 2010: 14:730–734. © 2010 John Wiley & Sons A/S. Abstract: SAB assays have increased the sensitivity and specificity to detect HLA alloantibodies, but there is uncertainty about the clinical relevance of SAB‐positive alloantibodies when the FCXM is negative. We performed a retrospective study to evaluate the clinical significance of SAB‐detected DSA in 82 pediatric recipients of a first kidney transplant between January 2000 and December 2005 who had a negative pretransplant FCXM. Pretransplant sera were evaluated by SAB for DSA. Graft loss and rejection between patients with (DSA+) and without DSA (DSA?) were compared. DSA were detected in 13.9%. Eighty percent of DSA+ subjects were DD transplant recipients vs. 56.9% in the DSA? cohort. The RR of graft loss in DSA+ vs. DSA? was 3.3 (95% CI, 1.4–7.9) and in DD was 4.3 (95% CI 1.4–13.1). By Cox regression, the HR of graft loss in DSA+ vs. DSA? was 2.8 (95% CI 0.7–10.9; p = 0.14) and in DD was 5.1 (95% CI 1–25.6; p = 0.05). Acute rejection occurred in 60% in the DSA+ vs. 44.4% in DSA? (p = 0.5). SAB‐detected DSA was associated with impaired renal allograft survival in pediatric renal transplant recipients. Impaired graft survival in pediatric renal transplant recipients with DSA detected by solid‐phase assays.