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논문분류	춘계학술대회 초록집
제목	Clinical Significance of De Novo Donor-Specific anti-HLA Antibodies after Kidney Transplantation
저자	Hee-Yeon Jung*, Kyu Yeun Kim1, Minjung Kim1, Wonseok Do1, Youngae Yang1, Taehoon Yim1, Inryang Hwang1, Su Kyung Lee1, Ji-Young Choi1, Jang-Hee Cho1, Sun-Hee Park1, Yong-Lim Kim1, Hyung-Kee Kim2, Seung Huh2, Chan-Duck Kim1
출판정보	2016; 2016(1):
키워드	Antibody-mediated rejection, de novo donor-specific antibodies, kidney transplantation, survival
초록	Background: The goal of this study was to investigate the impact of de novo donor-specific anti-HLA antibodies (DSA) on antibody-mediated rejection (AMR) and characterize DSA leading to AMR in kidney transplant recipients (KTRs). Methods: We included 174 KTRs without pretransplant anti-HLA antibodies. All the enrolled KTRs were prospectively screened for the development of de novo DSA every 3 months before 1 year posttransplant and annually thereafter. DSA were determined by Luminex assays and expressed as mean fluorescence intensity (MFI). AMR was diagnosed by indication biopsy of allograft. Results: Of 174 KTRs, 17 KTRs (9.8%) developed de novo DSA during a mean follow-up of 32.3±13.5 months. The average time to first detection of de novo DSA was 28.2 months after kidney transplantation. All of de novo DSA were against class II antigens (11 DQ, 1 DR, and 5 both). The mean number of DSA was 1.8±1.2, ranging from 1 to 5 and mean MFI of DSA was 7277.6±5320.4. Acute AMR occurred only in KTRs with de novo DSA compared to KTRs without de novo DSA (17.6% versus 0%, P=0.001). In the KTRs with acute AMR, allograft biopsy was performed 108.3±95.5 days after development of de novo DSA. Allograft survival was not different between two groups. There were no differences in the number of DSA and mean MFI of DSA between de novo DSA positive KTRs with AMR and de novo DSA positive KTRs without AMR. Conclusion: Regular immunological monitoring is needed in KTRs to detect DSA because de novo DSA increased incidence of acute AMR. Close clinical monitoring and prompt interventions are mandatory in KTRs with de novo DSA, regardless of the number and strength of DSA, to reduce allograft damage induced by AMR.
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