De-novo anti-DQ antibodies as a risk factor for kidney allograft failure
- VernacularTitle:Бөөрний суулгацын амьдрах чадварт de-novo anti-DQ эсрэгбие сөргөөр нөлөөлөх нь
- Author:
Sarantsetseg J
1
;
Oyunbileg B
1
;
Оdgerel D
1
;
Narandulam B
1
;
Batbaatar G
2
;
Munkhbat B
2
Author Information
1. The First Central Hospital of Mongolia, HLA laboratory
2. Mongolian National University of Medical Sciences
- Publication Type:Journal Article
- Keywords:
de-novo anti DQ antibody;
kidney graft survival
- From:
Health Laboratory
2019;9(1):33-38
- CountryMongolia
- Language:Mongolian
-
Abstract:
Background:De-novo donor and non-donor specific antibodies could be detrimental to
the kidney allograft. Kidney transplantation has being performed in Mongolia since 2006.
However there is currently no published data available on post-transplant de-novo
antibodies and long-term graft survival. Our aim was to determine immunosuppressive
drug through level, its combination, de-novo HLA antibodies and its influence on graft
survival in different immunosuppressive protocols.
Methods:We analyzed data from 56 adult first kidney transplant recipients at our hospital
from August 2006 to May 2013. We determined the level of tacrolimus, cyclosporine A,
and the presence of pre and post-transplant anti-HLA antibodies.
Results:Post-transplant follow up period was 1-8 years. Mean recipient age on
transplantation was 33.9±9.1 years. Male 45 (80.4%). Cadaver donor kidney was 5 (8.9%).
Mean donor age on transplantation was 39.98±11.13 years. Rejection occurrence was 12(21.4%). Tacrolimus and cyclosporine A through levels were 3-12.8ng/ml and 65-
324ng/ml respectively. Anti-HLA class I antibodies were detected in 17.9% of pretransplantation (n=10) and in 23.2% of post-transplantation (n=13) cases respectively
(p=0.607). On the other hand, anti-HLA class II antibodies were detected in 5.4% of pretransplantation (n=3) and in 33.9% of post-transplantation (n=19) cases (p=0,001). We
determined anti-HLA class II antibody specificity. Anti-DQ, DR, DP antibodies were 25% (
n=14), 14.3% ( n=8) and 7.1% ( n=4) respectively on all 56 cases. Two (3.6%) patients’
samples were positive on three loci of HLA class II. Six patient samples (10.7%) were
positive on two loci. Nine (64.3%) of anti-DQ positive patients have rejected their grafts
and begun hemodialysis treatment. All 9 graft rejected recipients were anti-HLA DQ
positive and had taken cyclosporine mono-therapy for the first year after transplantation.
Conclusion:The presence of de-novo anti-HLA class II antibodies, especially de-novo anti-DQ were significantly increased on cyclosporine mono-therapy group following transplantation and negatively affected kidney graft survival. The blood through level of cyclosporine was very variable. The graft survival was better in standard triple regimen.
Therefore, it is essential to monitor immunosuppressive drug combinations with drug blood level and anti-DSA antibodies as well as to manage antibody removal therapies such as therapeutic plasma exchange, intravenous immunoglobulin and Rituximab therapy on time. HLA –DQ-DP antigen determination is important for the kidney transplantation.
- Full text:HL-2019-9(1)-33-38.pdf
