The Effect of Preformed Anti-Human Leukocyte Antigens Antibodies on Graft and Patient Outcomes in Kidney Transplantation

Objective: Kidney transplantation is the most suitable kidney replacement therapy for patients with end-stage kidney disease. The relationship between the pretransplant antibodies detected by Luminex Single Antigen Bead test and the clinical outcome is still unclear. In this study, we aimed to examine the effects of pretransplant anti-human leukocyte antigen antibody status on graft functions, posttransplant complications, graft, and patient survival in kidney transplantation recipients.

Methods: Two hundred eleven patients who underwent kidney transplantation between January 2015 and July 2020 were included in the study. Detailed immunological assessment, donor and recipient characteristics, posttransplant immunological and non-immunological complications, graft loss, and death were analyzed.

Results: Thirty-three (15.6%) patients were donor-specific antibody positive, 58 (27.5%) patients were non-donor-specific antibody positive, and 120 (56.9%) patients were anti-human leukocyte antigen antibody negative. There was no significant difference between these groups in terms of acute rejection, opportunistic infections, urinary tract infections, malignancy, graft, and patient survival. The rate of desensitization therapy and antithymocyte globulin induction were higher in donor-specific antibody-positive group (P < .001 and < .001, respectively). Increased recipient and donor age and BK virus infection significantly decreased graft and patient survival in multivariate analyses.

Conclusion: Pretansplant donor-specific antibody and non-donor-specific antibody should not be a barrier for kidney transplantation. With the guidance of immunosuppression with advanced immunological risk assessment methods, kidney transplantation can be performed successfully in patients with high immunological risk.

Cite this article as: Karaoğlan M, Kumru G, Sadioğlu RE, et al. The effect of preformed anti-human leukocyte antigens antibodies on graft and patient outcomes in kidney transplantation. Turk J Nephrol. 2024;33(1):91-101.