Natural History of Proteinuria in Renal Transplant Recipients Developing De Novo Human Leukocyte Antigen Antibodies


Fortheringham J, Angel C, Goodwin J, Harmer AW, McKane WS


Patients with de novo DSA after renal transplantation showed significantly higher rates of acute rejection (74% vs. 41%), more graft losses (29% vs. 9%), lower glomerular filtration rate (GFR) at the time of antibody detection (31.8 ml/min/1.73m2 vs. 44.1 ml/min/1.73m2) and lower 3-year allograft survival (69.5 vs. 91.1%) than patients with NDSA. The GFR decline was -5.85 ml/min/1.73m2/year in DSA patients, which was significantly higher than the -3.21 ml/min/1.73m2/year and the -0.08 ml/min/1.73m2/year for the control patients. In regards to proteinuria, 45% of DSA positive patients had more than 3 g/L of protein in urine at the time of antibody detection compared to only 3% in NDSA  positive patients.