Donor-specific antibodies adversely affect kidney allograft outcomes

Sumit Mohan, Amudha Palanisamy, Demetra Tsapepas, Bekir Tanriover, R. John Crew, Geoffrey Dube, Lloyd E. Ratner, David J. Cohen, Jai Radhakrishnan

Research output: Contribution to journalArticlepeer-review

212 Scopus citations


The effect of low titers of donor-specific antibodies (DSAs) detected only by sensitive solid-phase assays (SPAs) on renal transplant outcomes is unclear. We report the results of a systematic review and meta-analysis of rejection rates and graft outcomes for renal transplant recipients with such preformed DSAs, defined by positive results on SPA but negative complement-dependent cytotoxicity and flow cytometry crossmatch results. Our search identified seven retrospective cohort studies comprising a total of 1119 patients, including 145 with isolated DSA-SPA. Together, these studies suggest that the presence of DSA-SPA, despite a negative flow cytometry crossmatch result, nearly doubles the risk for antibody-mediated rejection (relative risk [RR], 1.98; 95% confidence interval [CI], 1.36-2.89; P<0.001) and increases the risk for graft failure by 76% (RR, 1.76; 95% CI, 1.13-2.74; P=0.01). These results suggest that donor selection should consider the presence of antibodies in the recipient, identified by the SPA, even in the presence of a negative flow cytometry crossmatch result.

Original languageEnglish (US)
Pages (from-to)2061-2071
Number of pages11
JournalJournal of the American Society of Nephrology
Issue number12
StatePublished - 2012

ASJC Scopus subject areas

  • Nephrology


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