Donor-Specific Antibody Monitoring: Where Is the Beef?
Ma J, Patel A, and Tinckam K. Donor-specific antibody monitoring: Where is the beef? Adv Chronic Kidney Dis 2016; 23(5):317-325.
Advances in chronic kidney disease
This review paper discusses the impact of de novo donor-specific antibodies (DSA) to donor HLA antigens in kidney transplantation and summarizes the benefits and challenges that exist with DSA monitoring. Post-transplant DSA is associated with worse allograft outcomes and its detection may precede or coincide with clinical, biochemical, and histologic allograft dysfunction. There are no absolute features of DSA testing results that perfectly discriminate between states of disease and health. In a state of antibody-associated graft dysfunction, removal or reduction in DSA may only provide clinical benefit for some. Furthermore, various factors influence test results, and detection of HLA antibodies must be interpreted within the appropriate clinical and laboratory context. The utility of DSA monitoring is further affected by the limited effectiveness of treatment for antibody-mediated rejection. Although DSA monitoring is potentially beneficial in some circumstances, the optimal screening and treatment strategies are still to be defined.
Medical Subject Headings
Autoantibodies; Graft Rejection; Graft Survival; HLA Antigens; Humans; Kidney Transplantation; Tissue Donors