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논문분류	춘계학술대회 초록집
제목	The Clinical Impact of Preformed HLA-DQ donor-specific antibody on Graft outcomes in Kidney Transplantation
저자	SUA LEE, Eun Jeong Ko, Chul Woo Yang, Byung Ha Chung
출판정보	2020; 2020(1):
키워드	Kidney transplantation \| HLA-DQ donor-specific antibody \| Acute rejection
초록	De-novo HLA-DQ donor-specific antibody (DSA) has been identified as a risk factor for late graft dysfunction and graft loss in kidney transplantation (KT). Recently, the influence of preformed HLA-DQ DSA has been discussed. This study aimed to investigate the clinical impact of preformed HLA-DQ DSA on graft outcomes. We evaluated 990 recipients who underwent kideny transplantation at Seoul St. Mary's Hospital from January 2010 to July 2019. Recipients were classified as no DSA, only DQ, non-DQ, and DQ + non-DQ. Primary outcomes were the incidence of biopsy-proven acute rejection and the rate of death-censored graft loss. In total cohort, 611 recipients (61.7%) and 379 recipients (38.3%) underwent living-donor KT and deceased-donor KT, respectively. Recipients were classified as no DSA (909 recipients, 91.8%), only DQ (18 recipients, 1.8%), non-DQ (57 recipients, 6.3%), and DQ + non-DQ (6 recipients, 0.7%). The overall incidence of acute rejection and acute antibody-mediated rejection (AMR) were 20.3% and 7.5%. Only DQ, non-DQ, and DQ + non-DQ group had significantly higher the incidence of acute AMR compared to no DSA group (p<0.05, respectively). There was no significant difference in the incidence of acute AMR between sensitized groups. There was no difference in the rate of death-censored graft loss between groups. In univariate Cox regression analysis, all of 3 groups with DSA were associated with high risk of acute AMR (Only DQ: HR 5.051; CI 95%, p=0.002, non-DQ: HR 6.005; CI 95%, p<0.001, DQ + non-DQ: HR 7.748; CI 95%, p=0.005, respectively). HLA-DQ DSA and other DSAs (HLA-A, HLA-B, HLA-DR) had a tendency to interact with acute AMR (p=0.055). Preformed HLA-DQ DSA is associated with the development of acute rejection, especially acute AMR. Therefore, the identification of preformed HLA-DQ DSA may be necessary to improve graft outcomes.
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