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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Pre- and post-transplant C1q-binding HLA-antibodies affect clinical outcome of renal allografts

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  • Teresa Kauke - Klinikum der Universität München, Klinik für Allgemeine, Viszeral-, Transplantation-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Viviane Lin - Klinikum der Universität München, Klinik für Allgemeine, Viszeral-, Transplantation-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Ulf Schönermarck - Klinikum der Universität München, Med. Klinik IV, Schwerpunkt Nephrologie, München, Deutschland
  • Manfred Stangl - Klinikum der Universität München, Klinik für Allgemeine, Viszeral-, Transplantation-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Markus Guba - Klinikum der Universität München, Klinik für Allgemeine, Viszeral-, Transplantation-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Jens Werner - Klinikum der Universität München, Klinik für Allgemeine, Viszeral-, Transplantation-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Bruno Meiser - Klinikum der Universität München, Transplantationszentrum, München, Deutschland
  • Michael Fischereder - Klinikum der Universität München, Med. Klinik IV, Schwerpunkt Nephrologie, München, Deutschland
  • Antje Habichht - Klinikum der Universität München, Transplantationszentrum, München, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch633

doi: 10.3205/15dgch633, urn:nbn:de:0183-15dgch6330

Published: April 24, 2015

© 2015 Kauke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: The impact of donor-specific HLA-antibodies (DSA) on graft outcome in renal transplant patients is still a matter of debate. Differentiating HLA-antibodies by their ability to bind the complement product C1q might enable a better risk assessment. Therefore we thought to investigate the clinical relevance of pre- and post-transplant C1q HLA-antibodies on graft outcome in our center.

Material and methods: We retrospectively analyzed the sera of 523 renal allograft recipients who were transplanted in our center between January 2005 and December 2011. The presence of HLA-antibodies and their complement (C1q) binding capacity was studied by Luminex assay prior and after transplantation. Graft function (50% increase in creatinine in yearly intervals), acute rejection episodes (AR) and graft loss (GL) was assessed within a median follow-up of 3.5 years.

Results: We found DSA in 53/523 (10.1%) recipients. 36/53 (67.9%) DSA showed complement- binding ability (C1q ). The presence of C1q DSA either before or after transplantation was associated with the greatest risk of graft loss (11/36; 30.6%) as compared to no HLA antibodies (34/523; 7.2%, p<0.000) while C1q- DSA (3/17; 17.6%, p=0.252) showed no significant difference. AR occurred in 52.8% (19/36) of C1q DSA patients compared to 28% (133/470) HLA-antibody negative patients (p=0.002). Significantly more recipients with C1q DSA (36.0%, p=0.020) had worsening creatinine levels as compared to recipients with C1q- DSA (28.6%, p = 0.076) versus no HLA-antibodies (17.0%) within the first 2 years.

Conclusion: Distinguishing HLA-antibodies by their C1q-binding ability facilitates the identification of renal transplant recipients at immunologic risk.