Correlation of De correlation of De-Novo Donor-Specific Anti-HLA Antibodies with Acute Allograft Rejection after Kidney Transplantation: A Prospective Cohort Study

 

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Correlation of De correlation of De-Novo Donor-Specific Anti-HLA Antibodies with Acute Allograft Rejection after Kidney Transplantation: A Prospective Cohort Study

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Dr Priyanka
Kumari
Dr Priyanka Kumari jhajhariap5@gmail.com Army Hospital research and referral Nephrology New Delhi India *
Dr Vishal Singh vishal23415@gmail.com Army hospital research and referral Nephrology New delhi India -
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De novo donor-specific antibodies (dnDSA) emerging after kidney transplantation are considered key mediators of antibody-mediated rejection (ABMR). However, the temporal pattern and clinical correlation of dnDSA with rejection episodes remain incompletely understood, particularly in the Indian transplant population.


In this prospective cohort study, 75 renal allograft recipients were followed for 12 months post-transplant. Serum samples were analyzed for donor-specific anti-HLA Class I and II antibodies using Luminex single antigen bead assay at 3, 6, and 12 months. The occurrence of dnDSA and biopsy-proven acute rejection (BPAR) were correlated using Fisher’s exact test.


De novo DSA developed in 3 patients (4%)—Class I in 2 (2.7%) and Class II in 1 (1.3%). Seventeen patients (22.7%) experienced biopsy-proven rejection, including ABMR (12%), TCMR (6.7%), and mixed rejection (4%). Although dnDSA were infrequent, their occurrence showed a trend toward higher rejection rates (p=0.08) compared to patients without dnDSA. Most dnDSA appeared within the first 6 months post-transplant, and all were associated with preceding rise in mean fluorescence intensity (MFI). No significant demographic or immunologic predictors were identified for dnDSA formation.


In this prospective study, the development of dnDSA was uncommon but tended to associate with higher rates of acute rejection. Serial post-transplant DSA monitoring, particularly within the first 6 months, may help in early identification of recipients at increased risk of ABMR and optimize graft surveillance.


Kewords