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Article

C3d-Positive Preformed DSAs Tend to Persist and Result in a Higher Risk of AMR after Kidney Transplants

by
Sooin Choi
1,†,
Kyo Won Lee
2,†,
Jae Berm Park
2,
Kyunga Kim
3,
Hye-Ryeon Jang
4,
Wooseong Huh
4 and
Eun Suk Kang
5,*
1
Department of Laboratory Medicine, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan 31151, Korea
2
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
3
Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
4
Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
5
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
*
Author to whom correspondence should be addressed.
†
Contributed equally to this study.
J. Clin. Med. 2020, 9(2), 375; https://doi.org/10.3390/jcm9020375
Submission received: 23 December 2019 / Revised: 17 January 2020 / Accepted: 28 January 2020 / Published: 30 January 2020
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Abstract

C3d-binding assays have been introduced as methods for the prediction of the presence of complement-binding functional antibodies; however, the prognostic value of C3d-positive preformed donor-specific antibodies (pDSAs) has not been fully evaluated. In this study, we performed a retrospective investigation of the association of pDSAs and their C3d-binding capacity with one-year clinical outcomes. pDSAs were defined as donor-specific antibodies (DSAs) that were produced before kidney transplants (KTs) (pre-pDSAs) or within the first four weeks after KTs, owing to rebound immune response (post-pDSAs). Of 455 adult KT recipients, pre-pDSAs and post-pDSAs were found in 56 (12.3%) and 56 (12.3%) recipients, respectively, and C3d-positive post-pDSAs were found in 13 recipients (2.9%) in total. Approximately half of the C3d-negative pre-pDSAs (37/73, 50.7%) disappeared after transplantation; however, all C3d-positive pre-pDSAs (8/8, 100%) persisted after transplantation despite desensitization (p = 0.008). C3d-positive pDSAs were significantly associated with a higher incidence and risk of AMR (p < 0.001, OR 94.467–188.934). Identification of the C3d-binding activity of pDSAs before and early after KT is important for predicting the persistence of pDSAs and the risk of AMR induced by the presence of pDSAs.
Keywords: kidney transplant (KT); donor-specific antibodies (DSA); C3d-binding assay; antibody-mediated rejection (AMR) kidney transplant (KT); donor-specific antibodies (DSA); C3d-binding assay; antibody-mediated rejection (AMR)

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MDPI and ACS Style

Choi, S.; Lee, K.W.; Park, J.B.; Kim, K.; Jang, H.-R.; Huh, W.; Kang, E.S. C3d-Positive Preformed DSAs Tend to Persist and Result in a Higher Risk of AMR after Kidney Transplants. J. Clin. Med. 2020, 9, 375. https://doi.org/10.3390/jcm9020375

AMA Style

Choi S, Lee KW, Park JB, Kim K, Jang H-R, Huh W, Kang ES. C3d-Positive Preformed DSAs Tend to Persist and Result in a Higher Risk of AMR after Kidney Transplants. Journal of Clinical Medicine. 2020; 9(2):375. https://doi.org/10.3390/jcm9020375

Chicago/Turabian Style

Choi, Sooin, Kyo Won Lee, Jae Berm Park, Kyunga Kim, Hye-Ryeon Jang, Wooseong Huh, and Eun Suk Kang. 2020. "C3d-Positive Preformed DSAs Tend to Persist and Result in a Higher Risk of AMR after Kidney Transplants" Journal of Clinical Medicine 9, no. 2: 375. https://doi.org/10.3390/jcm9020375

APA Style

Choi, S., Lee, K. W., Park, J. B., Kim, K., Jang, H.-R., Huh, W., & Kang, E. S. (2020). C3d-Positive Preformed DSAs Tend to Persist and Result in a Higher Risk of AMR after Kidney Transplants. Journal of Clinical Medicine, 9(2), 375. https://doi.org/10.3390/jcm9020375

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