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Master Thesis

J’ai un DSA, c’est grave docteur ? De novo donor specific antibody initial and evolutive characteristics predictive of graft survival in kidney transplant recipients at Grenoble university hospital (the DYNAMIK study)

Abstract : Introduction: Occurrence of de-novo donor-specific antibodies (dnDSA) can reduce graft survival in kidney-transplant recipients (KTR). In this study, we assessed the initial and evolutive characteristics of dnDSA predictive of death-censored graft survival (DCGS). Materials & methods: All KTR at Grenoble University Hospital between 2008 and 2017 with no preformed DSA were included. Most patients received antithymocyte globulins as induction therapy and maintenance immunosuppression of tacrolimus and mycophenolic acid, plus early steroid-withdrawal. Results: 967 KTR were included. A dnDSA occurred in 65 (6.7%), after 2.2 years post transplantation. This resulted in antibody-mediated rejection (ABMR) in 30% of cases and graft loss in 40%. Compared to dnDSA-free patients, KTR that developed a class-2 dnDSA had significantly lower DCGS (HR=4.24, p<0.001). Multivariate prognostic factors associated with DCGS in patients that developed class 2 dnDSA were persisting dnDSA (p=0.01) and co-occurrence of class 1 dnDSA (p=0.001). Overall, 49% of KTR that developed a class-2 dnDSA received a specific treatment; however with no effect on DCGS (p=0.37) or raw survival (p=0.25). Selection bias probably caused the most severe cases of ABMR to be within the treated group. Overall, persisting dnDSA with a high initial MFI were the most detrimental, whereas transitory, low initial MFI dnDSA had a survival rate close to those of dnDSA-free KTR. Conclusion: In our cohort, dnDSA were infrequent but had poor outcomes. Nonetheless, dnDSA with a low initial MFI and infrequent detection over time were far less detrimental: these factors could allow KTR to be risk stratified at when developing a dnDSA.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03087038
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Wednesday, December 23, 2020 - 11:42:03 AM
Last modification on : Wednesday, January 6, 2021 - 3:24:59 AM

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  • HAL Id : dumas-03087038, version 1

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Catherine Casiez. J’ai un DSA, c’est grave docteur ? De novo donor specific antibody initial and evolutive characteristics predictive of graft survival in kidney transplant recipients at Grenoble university hospital (the DYNAMIK study). Human health and pathology. 2020. ⟨dumas-03087038⟩

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