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Evaluation of desensitizing therapies for donor-specific antibodies in confirmed humoral allograft rejection in kidney transplantation: experience of a center for 10 years

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dc.contributor.authorMartínez-Alcaraz, Marta
dc.contributor.authorGil, Mercedes
dc.contributor.authorLlorente, Santiago
dc.contributor.authorBotella, Carmen
dc.contributor.authorGalián, José Antonio
dc.contributor.authorGonzález-López, Rosana
dc.contributor.authorFernández-González, Marina
dc.contributor.authorAlegría, María José
dc.contributor.authorHita, Alicia
dc.contributor.authorMoya, María Rosa
dc.contributor.authorMartinez-Banaclocha, Helios
dc.contributor.authorMuro-Pérez, Manuel
dc.contributor.authorMuro, Javier
dc.contributor.authorMinguela, Alfredo
dc.contributor.authorLegaz Pérez, Isabel
dc.contributor.authorMuro, Manuel
dc.contributor.departmentCiencias Sociosanitarias
dc.contributor.otherFacultad de Química
dc.date.accessioned2026-05-11T09:59:46Z
dc.date.available2026-05-11T09:59:46Z
dc.date.copyright© 2026 Elsevier B.V. All rights are reserved
dc.date.issued2026-02-13
dc.description.abstractDonor-specific antibodies (DSAs) in the recipient's serum are directed against donor-mismatched Human Leukocyte Antigen (HLA) antigens found on graft endothelial cells. These DSAs may be responsible for antibody-mediated rejection (AMR) in patients undergoing kidney transplantation. Once they are developed in the post-transplant period, a desensitizing treatment must be instituted to reduce these DSAs and not cause damage to the graft. The objectives were to analyze our cases of confirmed AMR in a series of kidney recipients over 10 years and to assess the impact of the anti-rejection treatments (ART) on DSAs in these patients. Methods: This study evaluated the presence of DSAs in the sera of 33 patients, identified through Luminex, who developed DSAs associated with renal graft deterioration. Assessments were conducted at the time of the event and/or biopsy, with DSA levels ≥1500 mean fluorescence intensity (MFI) units considered positive. ART included plasma exchange, Intravenous Immunoglobulin (IVIG), boluses of methylprednisolone, anti-CD20, anti-IL-6R, or increased doses of immunosuppressants. Results: It was observed that ART with Tocilizumab shows the most decrease in MFI of DSAs over time (p < 0.05); this decrease occurs in most patients treated with progressive recovery of renal function. However, when we analyze the post-transplant ART in those patients with plasma exchange (PE), IVIG, and Rituximab, slightly heterogeneous data are observed, although some patients had a slight decrease in MFI of DSAs after treatment, the effect was not as apparent as with Tocilizumab. The results were also heterogeneous regarding the increase in immunosuppression, although there was a greater tendency to decrease the MFI of DSAs. HLA class I DSAs respond better to desensitizing treatment with PE/IVIG, while HLA class II DSAs, especially anti-DQ antibodies, show a more variable evolution. Conclusions: The use of Tocilizumab in chronic AMR produced the greatest decrease in the MFI of the DSAs and the recovery of the renal function of the graft compared to other ARTs. Treatment with PP/IA/IVIG/ Rituximab also showed greater variability in the face of a decrease in DSA, depending on the type of patient. Finally, increased immunosuppression as an ART also showed great variability, although with a greater tendency to decrease DSA. Our results should be evaluated with caution for our small number that could not draw definitive conclusions.
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dc.format.extent9
dc.identifier.citationTransplant Immunology 95 (2026) 102363
dc.identifier.doihttps://doi.org/10.1016/j.trim.2026.102363
dc.identifier.eissn1878-5492
dc.identifier.issn0966-3274
dc.identifier.urihttp://hdl.handle.net/10201/230802
dc.languageeng
dc.publisherElsevier
dc.relationThis research was funded by Virgen de la Arrixaca University Clinic Hospital and Biomedical Research Institute of Murcia (IMIB) (Murcia, Spain) within the framework of the PI19/01194 National Research Project funded by the Carlos III Health Institute (Madrid, Spain) and Mutua Madrile˜ na Foundation project AP183152023.
dc.relation.publisherversionhttps://www.sciencedirect.com/science/article/pii/S0966327426000213
dc.rights.accessRightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectDensitization antibody
dc.subjectTocilizumab
dc.subjectDonor specific antibody
dc.subjectAnti-CD20
dc.subjectKidney transplant
dc.subject.odsNo relacionado con ningún objetivo de desarrollo sostenible
dc.titleEvaluation of desensitizing therapies for donor-specific antibodies in confirmed humoral allograft rejection in kidney transplantation: experience of a center for 10 years
dc.typeinfo:eu-repo/semantics/article
dc.type.versioninfo:eu-repo/semantics/publishedVersion
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relation.isAuthorOfPublication.latestForDiscoveryb83b4b59-2d61-40f0-9108-5c6a6d158295
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