Clinical risk stratification of paediatric renal transplant recipients using C1q and C3d fixing of de novo donor-specific antibodies

• DOI: 10.1007/s00467-017-3772-7
• Publication Date: 2017-09-16T08:33:41Z
• Authors: Jon Jin Kim; Olivia Shaw; Chloe Martin; George Michaelides; Ramnath Balasubra...; Neil J. Sebire; Nizam Mamode; Anthony Dorling; Robert Vaughan; Stephen D. Marks
• Keywords: Nephrology; Concomitant

We have previously shown that children who developed de novo donor-specific human leukocyte antigen (HLA) antibodies (DSA) had greater decline in allograft function. hypothesised patients with complement-activating DSA would poorer renal outcomes. A total of 75 the original study. The first positive sample was subsequently tested for C1q and C3d fixing. primary event defined as 50% reduction from baseline estimated glomerular filtration rate analysed using Kaplan–Meier estimator. Of 65 tested, 32 (49%) 23 (35%) fixing, respectively. C1q-positive (c1q+) patients, 13 (41%) did not show concomitant mean fluorescence intensity values immunoglobulin G correlated poorly complement-fixing positivity (C1q: adjusted R 2 0.072; C3d: 0.11; p < 0.05). C1q+ were associated acute tubulitis [0.75 ± 0.18 (C1q+) vs. 0.25 0.08 (C1q−) episodes per patient (mean standard error mean; 0.05] but worse long-term dysfunction (median time to 5.9 6.4 years; hazard ratio (HR) 0.74; 95% confidence (CI) 0.30–1.81; = 0.58]. C3d-positive (C3d+) C4d histological staining [47% 20% (C3d−); 0.04] significantly [median event: 5.6 6.5 (C3d−) HR 0.38; CI 0.15–0.97; 0.04]. Assessment fixing part prospective HLA monitoring can potentially aid stratification at highest risk dysfunction.