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Posttransplant monitoring of de novo human leukocyte antigen donor-specific antibodies in kidney transplantation

Wiebe, Chrisa; Nickerson, Petera,b

Current Opinion in Organ Transplantation: August 2013 - Volume 18 - Issue 4 - p 470–477
doi: 10.1097/MOT.0b013e3283626149

Purpose of review To summarize the evidence supporting the negative impact of de novo donor-specific antibodies (dnDSA) in renal transplantation and to describe the natural history associated with the development of dnDSA.

Recent findings Recent studies have increased our appreciation of the risk factors that predispose to dnDSA while illuminating how these risk factors may relate to the pathophysiology underlying its development. In addition, details regarding the natural history of dnDSA are now available in the context of the different clinical pathologic phenotypes that occur in the patients in whom it develops. Common pitfalls in defining and monitoring dnDSA, when understood, may provide some explanation for the heterogeneity in published studies.

Summary Recognizing that dnDSA is a major cause of late graft loss, and, more importantly, is detectable in many cases long before dysfunction or graft loss occurs, identifies an opportunity to intervene and change the outcome for the patient.

aDepartment of Medicine and Immunology, University of Manitoba; Winnipeg, Manitoba, Canada

bDiagnostic Services of Manitoba, Winnipeg, Manitoba, Canada

Correspondence to Peter Nickerson, Canadian Blood Services Bldg, 312-777 William Avenue, Winnipeg, MB, Canada R3E 3R4. Tel: +1 204 789 1125; fax: +1 204 789 3942; e-mail:

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