Improving the histologic detection of donor-specific antibody-negative antibody-mediated rejection in kidney transplants.
Reinterpreting how donor-specific antibodies are scored within the Banff 2022 criteria let pathologists detect almost half again as many cases of antibody-mediated rejection in kidney transplants that had no detectable donor-specific antibody, matching results from molecular and blood-based tests.
Background
Emerging treatments for antibody-mediated rejection (ABMR) have heightened the importance of detecting ABMR when donor-specific antibody (DSA) testing is negative. The Trifecta-Kidney study examined how DSA interpretation affects histologic ABMR diagnosis.
Key findings
In 690 kidney transplant biopsies tested centrally for DSA, donor-derived cell-free DNA (dd-cfDNA), and molecular biopsy assessment (MMDx), lowering MFI cutoffs for DSA positivity did not improve detection. However, treating all DSA as positive within an AutoBanff 2022 algorithm identified 46% more ABMR cases with no measurable conventional DSA and increased agreement of histology with both dd-cfDNA and molecular ABMR.
Clinical implications
Validation using INTERCOMEX data confirmed that newly identified DSA-negative ABMR cases carried the same risk of graft loss as conventionally diagnosed cases, suggesting a practical refinement to Banff interpretation that improves ABMR case-finding relevant to trial enrollment and treatment decisions.
Category
Transplant
Source
American Journal of Transplantation
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