Donor-specific antibodies, HTA report 2013:7
Does monitoring of de novo DSA after kidney transplantation provide:
- earlier identification of transplant dysfunction or rejection?
- fewer loss of transplant grafts or patients back in dialysis?
- improved patient survival?
A systematic search of the literature identified 33 studies. Eight studies were included and evaluated. No randomized study was identified. The observational studies had no control groups. Sampling frequency of sera for DSA, type of surgery (kidney only or kidney and pancreas), living donor or not, regime for immunosuppression and follow up time varied.
De novo DSA developed in 17.4% (mean), (min 15% - max 27%) and could in a majority of the cases be detected only simultaneously or after rejection or clinical signs of transplant dysfunction, but not before.
Transplant dysfunction and rejection was more common in patients who developed de novo DSA. This observation may be used as a prognostic sign for graft function and survival and as abasis for adjustment of treatment.
More research is needed for further evaluation of the potential value of de novo DSA monitoring after kidney transplantation.
- The question whether dysfunction or rejection of a transplanted kidney can be detected earlier by adding monitoring of de novo DSA after transplantation cannot be answered. The level of evidence according to GRADE is insufficient (⊕).
- Due to the study designs the questions whether monitoring of de novo DSA after kidney transplantation reduces loss of transplants alternatively patients back in dialysis or improved patient survival cannot be answered.
This Health Technology Assessment has been conducted by Dan Hauzenberger, specialist in immunology, Karin Lindström, specialist in nephrology and Lars Wennberg specialist in transplant surgery in cooperation with Claes Lennmarken and Elisabeth Persson, both medical advisers, and their team, at the HTA-center in Stockholm County Council-Region Gotland, Sweden.
Included and exluded articles
Report in Swedish