Tac-MMF Versus CsA-MMF/CsA-AZA-Based Regimens in Development of De Novo Complement-Binding Anti-HLA Antibodies After Kidney Transplantation.

Abstract

Background. Immunosuppressive regimens with tacrolimus or cyclosporine A (CsA)were compared for graft-related outcomes in conjunction with complement-binding denovo donor-specific antibodies (DSAs).Methods. Non-sensitized adult patients without rejection episodes within 3 months aftertransplantation were screened for the presence of de novo DSAs and C1q binding. Clinicaland biopsy data were retrospectively obtained.Results. The analysis included 118 patients (68 tacrolimus, 50 CsA), with mean age andfollow-up of 36.1 11.4 and 7.2 4.8 years, respectively. As compared with tacrolimus, theCsA group had higher rates of both class II DSAs and C1q-binding DSAs (20% vs 4.4%,P .008, and 18% vs 0%, P .003, respectively). Rates of chronic antibody-mediatedrejection (cAMR), proteinuria >500 mg/g, and levels of creatinine both at last visitswere also higher in the CsA group (20% vs 0%, P .002, 30% vs 5.9%, P .005, 1.67 1.31 vs 1.18 0.45 mg/dL, P .019, respectively).Class II DSAs and C1q-bindingclass II DSAs were significantly correlated with the clinical outcomes (creatinine levels,proteinuria, and cAMR).Conclusions. Compared with tacrolimus, CsA appears to pose a higher risk for thedevelopment of de novo anti-HLA antibodies with C1q-binding properties and,consequently, adverse graft-related outcomes.