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논문분류	춘계학술대회 초록집
제목	The Clinical Utility of Preformed C1q-binding donor-specific HLA antibodies in Kidney Transplantation
저자	SUA LEE, Eun Jeong Ko, Byung Ha Chung, Chul Woo Yang
출판정보	2020; 2020(1):
키워드	Kidney transplantation \| Preformed C1q-binding DSA \| Acute antibody-mediated rejecti
초록	Anti-human leukocyte antigen (HLA) antibodies are known for risk factor of allograft dysfunction in kidney transplantation (KT). De novo complement component 1q-binding donor-specific anti-HLA antibodies (C1q-binding DSAs) are reported to be associated with an increased risk of acute allograft rejection in KT. This study investigated the clinical utility of preformed C1q-binding DSAs for predicting graft outcomes in KT. From December 2016 to December 2018, 323 recipients underwent KT at Seoul St. Mary's Hospital. If panel reactive antibodies (PRA) were positive in the pre-transplant, DSAs and C1q-binding DSAs were performed using Luminex Single Antigen Bead Assay (SAB). Acute rejection and graft survival were compared between recipients with preformed C1q-binding DSAs and recipients without preformed C1q-binding DSAs. Eighty-two of 323 recipients (25.4%) were evaluated DSAs and C1q-binding DSAs before KT. Among them, 40 recipients (48.8%) had preformed DSAs and 8 recipients (9.9%) had preformed C1q-binding DSAs. There were no significant difference in basic demographics except for administration of bortezomib for desensitization between C1q-binding DSAs(-) group and C1q-binding DSAs(+) group. The higher MFI values of DSAs had higher prevalence of C1q-binding DSAs (9263.9 ± 3670.3 vs. 5955.3 ± 5245.5; p = 0.050). There was a strong correlation between the presence of DSAs against Class II and C1q-binding DSAs (p = 0.007; CI 95%, OR 9.333). There was a correlation between positivity of crossmatch and preformed C1q-binding DSAs (p = 0.024;CI 95%, OR 6.042). Four of 8 recipients (50%) in C1q-binding DSAs(+) group were confirmed acute antibody-mediated rejection by allograft biopsy. This result showed that C1q-binding DSAs(+) group had significantly higher incidence of acute antibody mediated rejection than that of C1q-binding DSAs(-) group (p=0.044; CI 95%, OR 4.286). The surveillance such as protocol allograft biopsy is required for early detection of acute antibody-mediated rejection after transplantation for patients with preformed C1q-binding DSAs.
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