Evidence map›Paper›PMID 40308598›Full record

ArticleFrontiers in immunology2025

Increasing donor kidney age significantly aggravates the negative effect of pretransplant donor-specific anti-HLA antibodies on kidney graft survival.

Michiel G H Betjes, Judith A Kal-van Gestel, Dave Roelen, Marcia M L Kho, Sebastian Heidt, Annelies E de Weerd, Jacqueline van de Wetering

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Article in Frontiers in immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Michiel G H BetjesDepartment of Internal Medicine, Erasmus Medical Center Transplant Institute, University Medical Center, Rotterdam, Netherlands.
Judith A Kal-van GestelDepartment of Internal Medicine, Erasmus Medical Center Transplant Institute, University Medical Center, Rotterdam, Netherlands.
Dave RoelenDepartment of Immunology, Leiden University Medical Center, Leiden, Netherlands.
Marcia M L KhoDepartment of Internal Medicine, Erasmus Medical Center Transplant Institute, University Medical Center, Rotterdam, Netherlands.
Sebastian HeidtDepartment of Internal Medicine, Erasmus Medical Center Transplant Institute, University Medical Center, Rotterdam, Netherlands.
Annelies E de WeerdDepartment of Internal Medicine, Erasmus Medical Center Transplant Institute, University Medical Center, Rotterdam, Netherlands.
Jacqueline van de WeteringDepartment of Internal Medicine, Erasmus Medical Center Transplant Institute, University Medical Center, Rotterdam, Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and hypothesis: The presence of donor-specific anti-HLA antibodies before kidney transplantation (preDSAs) is associated with decreased graft survival. The hypothesis that increasing donor kidney age is negatively associated with the impact of preDSA on graft survival was investigated. Methods: Outcome of kidney transplantation in a single center cohort of 2,024 patients transplanted between 2010 and 2020 with a follow-up of at least 3 years was analyzed to assess this relation. Results: DSAs before transplantation were present in 14% of recipients and showed an independent association with graft loss. The preDSA against HLA class I (2%) or class II (7%) had an adjusted hazard ratio (HR) for death censored graft failure of 5.8 (95% CI 4.4-7.7), while the combination (5%) had an HR of 18.6 (95% CI 13.8-25.1). The preDSA-associated increase in graft failure was caused primarily by an increase in the incidence of antibody-mediated rejection (ABMR), intragraft thrombosis, and primary non-function. These effects were observed more frequently in the deceased donor kidney transplantations compared to living donor kidney transplantations. The incidence of ABMR was not associated with donor kidney age. However, increasing donor kidney age significantly aggravated the negative effect of preDSA on graft survival. For instance, recipients aged ≥65 years transplanted with a deceased donor kidney aged ≥65 years had an uncensored 1- and 3-year graft survival of 83% and 67%, respectively, if transplanted without DSA. This decreased to 56% and 35% if transplanted in the presence of DSA. For comparison, recipients aged ≥65 years of a deceased donor kidney aged <65 years had an uncensored 1- and 3-year graft survival of 92% and 78%, respectively, without preDSA, and if transplanted with preDSA, this decreased to 77% and 69%, respectively. Conclusions: The negative effect of circulating DSA at the time of transplantation on both early and late death-censored graft survival is heavily influenced by donor age.

Indexed as

Graft RejectionGraft SurvivalHLA AntigensIsoantibodiesKidney TransplantationTissue DonorsAdultAgedAge FactorsFemaleHumansMaleMiddle AgedHLA AntigensIsoantibodiesage donor kidneyantibody-mediated rejectiondonor-specific anti-HLA antibodiesgraft survivalkidney transplantation

Identifiers

PMID40308598
PMCPMC12040950

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