Patients who have complement-binding donor-specific antibodies to human leukocyte antigens (HLAs) after kidney transplantation have a nearly five-fold higher risk of graft loss, according to a study published in the New England Journal of Medicine.

Alexandre Loupy, M.D., Ph.D., from Hôpital Necker in Paris, and colleagues screened 1,016 patients who received kidney allografts for the presence of circulating donor-specific anti-HLA antibodies and their complement-binding capacity.

The researchers found that five-year graft survival was significantly lower in patients with complement-binding versus non-complement-binding donor-specific anti-HLA antibodies (54 versus 93 percent) and versus patients without donor-specific anti-HLA antibodies (54 versus 94 percent). After adjusting for various factors, patients with complement-binding donor-specific anti-HLA antibodies also had a considerably higher risk of graft loss (hazard ratio 4.78). The addition of the presence of complement-binding donor-specific anti-HLA antibodies to a traditional risk model improved the prediction of graft failure.

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“We found that the presence of complement-binding anti-HLA donor-specific antibodies after transplantation is strongly associated with graft injury and loss and that incorporation of this risk factor improves risk stratification for graft loss,” Loupy and colleagues conclude.