AUTHOR=Phillpott Mason , Daga Sunil , Higgins Rob , Lowe David , Krishnan Nithya , Zehnder Daniel , Briggs David , Khovanova Natalia 

TITLE=Dynamic Behaviour of Donor Specific Antibodies in the Early Period Following HLA Incompatible Kidney Transplantation

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10128

DOI=10.3389/ti.2022.10128

ISSN=1432-2277

ABSTRACT=In HLA-incompatible kidney transplantation, monitoring of donor-specific antibodies (DSA) plays a crucial role in providing appropriate treatment and increases kidney survival times. As daily DSA monitoring is expensive, various studies explore the links between DSA levels and transplant outcomes at particular time points. This work aimed to determine if early post-transplant DSA dynamics were informative of graft outcome over and above other predictive factors. Eighty-eight cases were classified by unsupervised machine learning into five distinct groups: no response, fast modulation, slow modulation, rise to sustained and sustained. Fast modulation dynamics demonstrated an 87% rate for early acute rejection, whereas the sustained group was associated with the lowest rejection rates (19%). This can almost be viewed in complete contrast to the five-year graft failure, which saw 4-7% rates in modulation groups and 25-31% in the sustained groups. Multivariable analysis suggested a higher pre-treatment DSA level, male gender and absence of early acute rejection strongly associated with a sustained DSA response. In particular, the modulation group had excellent five-year outcomes despite higher rates of early rejection episodes. This work further develops an understanding of post-transplant AiT kidney DSA dynamics and their influence on graft survival.