SynthesisFrontiers in immunology2025
Association of donor-specific antibodies with adverse outcomes in solid organ transplantation: A systematic review and meta-analysis of 69 studies.
Synthesis 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 3 papers.
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Who cites it
3 citing papers in PubMed.
- ISOT Position Statement on Immunological Evaluation in Kidney Transplantation.Clinical transplantation · 2026Article
- Risk Phenotyping Before Graft Implantation: FTIR Spectroscopy and Machine Learning for Complementary Risk Stratification in Kidney Transplantation.Medical sciences (Basel, Switzerland) · 2026Article
- HLA incompatibility mitigation strategies in off-the-shelf cancer immunotherapies: clinical implications and a practical framework for strategy selection and combination.Frontiers in immunology · 2026Article
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5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Importance: Preformed donor-specific antibodies (pre-DSAs) are a significant immunologic barrier in solid organ transplantation (SOT), yet their association with post-transplant outcomes lacks consensus, limiting standardized clinical management. Objective: To determine the association between pre-DSA and posttransplant complications, including antibody-mediated rejection (AMR), T cell-mediated rejection (TCMR), graft loss, and patient mortality, with subgroup analyses stratified by organ type and MFI thresholds (1,000 cutoff). Data sources: Systematic review of 3,322 studies from PubMed, Embase and the Cochrane Library (from inception to February 2024) following the PRISMA guidelines. Study selection: Sixty-nine observational studies (22,737 transplant recipients; 3,787 pre-DSAs+), including retrospective and prospective cohorts, encompassing kidney (KT) (41 studies), liver (LT) (13), lung (6), heart (3), and other organ transplants. Main outcomes and measures: Primary: AMR, TCMR, graft loss, patient death.Secondary: Biliary complications, bacteremia, delayed graft function (DGF). Results: Pre-DSAs positivity conferred significantly elevated risks of AMR (RR = 5.21, 95%CI 4.01-6.79), graft loss (RR = 2.11, 1.72-2.60), and mortality (RR = 1.62, 1.39-1.89) compared with pre-DSAs-negative recipients, with marked heterogeneity across organ types. KTs faced the highest risk of AMR risk (RR = 6.09, 4.39-8.46), whereas LT recipients exhibited elevated mortality (RR = 1.81, 1.30-2.53) but lower AMR rates (RR = 1.81 Conclusions: Pre-DSAs is a strong independent predictor of AMR and graft loss in SOT, with amplified risks in KT and cohorts with DSA+ MFI≥1,000. These findings advocate for universal pretransplant DSAs screening and DSA+MFI-guided desensitization to prioritize high-risk patients. Organ-specific strategies, intensified AMR surveillance in KTs, and mortality-focused monitoring in LTs, are critical to improving outcomes.
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