Persistent versus resolved donor-specific antibodies predict 10-year antibody-mediated rejection and kidney transplant outcomes in Thailand
1
Issued Date
2025-12-01
Resource Type
eISSN
20452322
Scopus ID
2-s2.0-105009541266
Journal Title
Scientific Reports
Volume
15
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Scientific Reports Vol.15 No.1 (2025)
Suggested Citation
Thammathiwat T., Udomkarnjananun S., Wuttiputhanun T., Banjongjit A., Wattanaburanon C., Sainont G., Kaewkungwal J., Wattanatorn S., Tungsanga K., Praditpornsilpa K., Avihingsanon Y., Townamchai N. Persistent versus resolved donor-specific antibodies predict 10-year antibody-mediated rejection and kidney transplant outcomes in Thailand. Scientific Reports Vol.15 No.1 (2025). doi:10.1038/s41598-025-07681-4 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111140
Title
Persistent versus resolved donor-specific antibodies predict 10-year antibody-mediated rejection and kidney transplant outcomes in Thailand
Corresponding Author(s)
Other Contributor(s)
Abstract
Preformed donor-specific HLA antibodies (DSA) are a major risk factor for antibody-mediated rejection (ABMR) and graft loss after kidney transplantation. While pre-transplant desensitization can reduce DSA levels, the impact of persistent vs. resolved DSA on long-term outcomes remains unclear. This study investigated the association between post-transplant DSA status and clinical outcomes in kidney transplant recipients. This retrospective cohort study investigated the impact of post-transplant DSA persistence on clinical outcomes in kidney transplant recipients at King Chulalongkorn Memorial Hospital between 2009 and 2019. Patients with pre-transplant DSA positivity (detected by Luminex but negative by CDC-AHG) were categorized into ‘resolved’ (DSA < 500 MFI) and ‘persistent’ (DSA > 500 MFI) groups based on post-transplant Luminex results. Outcomes evaluated included biopsy-proven acute rejection (ABMR and TCMR), graft loss, mortality, and post-transplant complications. A total of 50 KTr were enrolled in the study. The median (interquartile range, IQR) DSA level was 1,556 (3,491) MFI for class I and 0 (888) MFI for class II. 57% of patients underwent pre-transplant desensitization. The median follow-up time after transplantation was 5.5 (IQR 3.3) years. The group with persistent DSA (n = 16) exhibited a significant higher rate of ABMR compared to the group with resolved DSA (n = 34) (p = 0.047, log-rank test). Factors associated with persistent DSA included recipient age over 50 and lower tacrolimus levels at six months (less than 7.25 ng/mL). Monitoring DSA levels is crucial in kidney transplant recipients, as persistent DSA is strongly associated with an increased risk of ABMR. Maintaining higher tacrolimus levels at 6 months tends to resolve DSA post-transplant. For patients with persistent DSA, surveillance biopsies should be considered to facilitate early detection and treatment of rejection, thus preserving kidney allograft function.