Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization
Recipient sensitization is a major risk factor of antibody-mediated rejection (ABMR) and inferior graft survival. The predictive effect of solid-phase human leukocyte antigen antibody testing and flow cytometry crossmatch (FCXM) in the era of peritransplant desensitization remains poorly understood....
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.780636/full |
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| author | Klara Osickova Petra Hruba Katerina Kabrtova Jiri Klema Jana Maluskova Jana Maluskova Antonij Slavcev Janka Slatinska Tomas Marada Georg A. Böhmig Ondrej Viklicky |
| author_facet | Klara Osickova Petra Hruba Katerina Kabrtova Jiri Klema Jana Maluskova Jana Maluskova Antonij Slavcev Janka Slatinska Tomas Marada Georg A. Böhmig Ondrej Viklicky |
| author_sort | Klara Osickova |
| collection | DOAJ |
| description | Recipient sensitization is a major risk factor of antibody-mediated rejection (ABMR) and inferior graft survival. The predictive effect of solid-phase human leukocyte antigen antibody testing and flow cytometry crossmatch (FCXM) in the era of peritransplant desensitization remains poorly understood. This observational retrospective single-center study with 108 donor-specific antibody (DSA)-positive deceased donor kidney allograft recipients who had undergone peritransplant desensitization aimed to analyze variables affecting graft outcome. ABMR rates were highest among patients with positive pretransplant FCXM vs. FCXM-negative (76 vs. 18.7%, p < 0.001) and with donor-specific antibody mean fluorescence intensity (DSA MFI) > 5,000 vs. <5,000 (54.5 vs. 28%, p = 0.01) despite desensitization. In univariable Cox regression, FCXM positivity, retransplantation, recipient gender, immunodominant DSA MFI, DSA number, and peak panel reactive antibodies were found to be associated with ABMR occurrence. In multivariable Cox regression adjusted for desensitization treatment (AUC = 0.810), only FCXM positivity (HR = 4.6, p = 0.001) and DSA number (HR = 1.47, p = 0.039) remained significant. In conclusion, our data suggest that pretransplant FCXM and DSA number, but not DSA MFI, are independent predictors of ABMR in patients who received peritransplant desensitization. |
| first_indexed | 2024-12-22T22:14:22Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-22T22:14:22Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-aa309828b62a477e8d55ce429e736d102022-12-21T18:10:49ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-12-01810.3389/fmed.2021.780636780636Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant DesensitizationKlara Osickova0Petra Hruba1Katerina Kabrtova2Jiri Klema3Jana Maluskova4Jana Maluskova5Antonij Slavcev6Janka Slatinska7Tomas Marada8Georg A. Böhmig9Ondrej Viklicky10Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, CzechiaTransplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, CzechiaDepartment of Immunogenetics, Institute for Clinical and Experimental Medicine, Prague, CzechiaDepartment of Computer Science, Faculty of Electrical Engineering, Czech Technical University, Prague, CzechiaDepartment of Pathology, Institute for Clinical and Experimental Medicine, Prague, CzechiaAesculab Pathology, Prague, CzechiaDepartment of Immunogenetics, Institute for Clinical and Experimental Medicine, Prague, CzechiaDepartment of Nephrology, Institute for Clinical and Experimental Medicine, Prague, CzechiaDepartment of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, CzechiaDivision of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, AustriaDepartment of Nephrology, Institute for Clinical and Experimental Medicine, Prague, CzechiaRecipient sensitization is a major risk factor of antibody-mediated rejection (ABMR) and inferior graft survival. The predictive effect of solid-phase human leukocyte antigen antibody testing and flow cytometry crossmatch (FCXM) in the era of peritransplant desensitization remains poorly understood. This observational retrospective single-center study with 108 donor-specific antibody (DSA)-positive deceased donor kidney allograft recipients who had undergone peritransplant desensitization aimed to analyze variables affecting graft outcome. ABMR rates were highest among patients with positive pretransplant FCXM vs. FCXM-negative (76 vs. 18.7%, p < 0.001) and with donor-specific antibody mean fluorescence intensity (DSA MFI) > 5,000 vs. <5,000 (54.5 vs. 28%, p = 0.01) despite desensitization. In univariable Cox regression, FCXM positivity, retransplantation, recipient gender, immunodominant DSA MFI, DSA number, and peak panel reactive antibodies were found to be associated with ABMR occurrence. In multivariable Cox regression adjusted for desensitization treatment (AUC = 0.810), only FCXM positivity (HR = 4.6, p = 0.001) and DSA number (HR = 1.47, p = 0.039) remained significant. In conclusion, our data suggest that pretransplant FCXM and DSA number, but not DSA MFI, are independent predictors of ABMR in patients who received peritransplant desensitization.https://www.frontiersin.org/articles/10.3389/fmed.2021.780636/fullkidneytransplantation-kidneyHLA incompatibilitydonor specific antibodiesrejectionflow cytometry |
| spellingShingle | Klara Osickova Petra Hruba Katerina Kabrtova Jiri Klema Jana Maluskova Jana Maluskova Antonij Slavcev Janka Slatinska Tomas Marada Georg A. Böhmig Ondrej Viklicky Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization Frontiers in Medicine kidney transplantation-kidney HLA incompatibility donor specific antibodies rejection flow cytometry |
| title | Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization |
| title_full | Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization |
| title_fullStr | Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization |
| title_full_unstemmed | Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization |
| title_short | Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization |
| title_sort | predictive potential of flow cytometry crossmatching in deceased donor kidney transplant recipients subjected to peritransplant desensitization |
| topic | kidney transplantation-kidney HLA incompatibility donor specific antibodies rejection flow cytometry |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.780636/full |
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