AUTHOR=de Rougemont Olivier , Deng Yun , Frischknecht Lukas , Wehmeier Caroline , Villard Jean , Ferrari-Lacraz Sylvie , Golshayan Déla , Gannagé Monique , Binet Isabelle , Wirthmueller Urs , Sidler Daniel , Schachtner Thomas , Schaub Stefan , Nilsson Jakob , the Swiss Transplant Cohort Study , Amico Patrizia , Axel Andres , Aubert John David , Banz Vanessa , Sonja Beckmann , Beldi Guido , Berger Christoph , Berishvili Ekaterine , Binet Isabelle , Bochud Pierre-Yves , Branca Sanda , Bucher Heiner , Carrel Thierry , Catana Emmanuelle , Chalandon Yves , De Geest Sabina , De Rougemont Olivier , Dickenmann Michael , Dreifuss Joëlle Lynn , Duchosal Michel , Fehr Thomas , Ferrari-Lacraz Sylvie , Franscini Nicola , Garzoni Christian , Soccal Paola Gasche , Gaudet Christophe , Golshayan Déla , Goossens Nicolas , Hadaya Karine , Halter Jörg , Heim Dominik , Hess Christoph , Hillinger Sven , Hirsch Hans , Hirt Patricia , Hofbauer Günther , Huynh-Do Uyen , Immer Franz , Koller Michael , Laager Mirjam , Laesser Bettina , Lehmann Roger , Leichtle Alexander , Lovis Christian , Manuel Oriol , Marti Hans-Peter , Martin Pierre Yves , Martinelli Michele , McLin Valérie , Mellac Katell , Mercay Aurelia , Mettler Karin , Mueller Nicolas , Müller Antonia , Müller Thomas , Müller-Arndt Ulrike , Müllhaupt Beat , Nägeli Mirjam , Oldani Graziano , Pascual Manuel , Posfay-Barbe Klara , Rick Juliane , Rosselet Anne , Rossi Simona , Rothlin Silvia , Ruschitzka Frank , Schanz Urs , Schaub Stefan , Schnyder Aurelia , Schuurmans Macé , Sengstag Thierry , Simonetta Federico , Staufer Katharina , Stampf Susanne , Steiger Jürg , Stirniman Guido , Stürzinger Ueli , Van Delden Christian , Venetz Jean-Pierre , Villard Jean , Vionnet Julien , Wick Madeleine , Wilhlem Markus , Yerly Patrick TITLE=Donation type and the effect of pre-transplant donor specific antibodies – Data from the Swiss Transplant Cohort Study JOURNAL=Frontiers in Immunology VOLUME=14 YEAR=2023 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2023.1104371 DOI=10.3389/fimmu.2023.1104371 ISSN=1664-3224 ABSTRACT=Introduction

The type of donation may affect how susceptible a donor kidney is to injury from pre-existing alloimmunity. Many centers are, therefore, reluctant to perform donor specific antibody (DSA) positive transplantations in the setting of donation after circulatory death (DCD). There are, however, no large studies comparing the impact of pre-transplant DSA stratified on donation type in a cohort with a complete virtual cross-match and long-term follow-up of transplant outcome.

Methods

We investigated the effect of pre-transplant DSA on the risk of rejection, graft loss, and the rate of eGFR decline in 1282 donation after brain death (DBD) transplants and compared it to 130 (DCD) and 803 living donor (LD) transplants.

Results

There was a significant worse outcome associated with pre-transplant DSA in all of the studied donation types. DSA directed against Class II HLA antigens as well as a high cumulative mean fluorescent intensity (MFI) of the detected DSA showed the strongest association with worse transplant outcome. We could not detect a significant additive negative effect of DSA in DCD transplantations in our cohort. Conversely, DSA positive DCD transplants appeared to have a slightly better outcome, possibly in part due to the lower mean fluorescent intensity (MFI) of the pre-transplant DSA. Indeed when DCD transplants were compared to DBD transplants with similar MFI (<6.5k), graft survival was not significantly different.

Discussion

Our results suggest that the negative impact of pre-transplant DSA on graft outcome could be similar between all donation types. This suggests that immunological risk assessment could be performed in a similar way regardless of the type of donor kidney transplantation.