Immunologic clustering of donor-specific antibodies and clinical outcomes in kidney transplant recipients

doi:10.5500/wjt.v16.i2.118450

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Jun 18, 2026; 16(2): 118450
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118450

Table 4 Comparison of cluster features (univariate analysis), n (%)

Variable	High risk (n = 58)	Intermediate risk (n = 34)	Low risk (n = 20)	P value	Significance
Donor and recipient
Recipient gender				0.9388	Not significant
Male	30 (51.7)	17 (50.0)	11 (55.0)
Female	28 (48.3)	17 (50.0)	9 (45.0)
Recipient age, median (IQR)	46.5 (31.5-59.8)	51.5 (39.5-2.8)	42.5 (36.5-52.8)	0.1989	Not significant
Donor gender				0.2735	Not significant
Male	37 (63.8)	27 (79.4)	13 (65.0)
Female	21 (36.2)	7 (20.6)	7 (35.0)
Donor age, median (IQR)	35.5 (29.0-44.0)	35.0 (29.0-43.2)	32.5 (27.2-39.2)	0.3195	Not significant
Donor type				0.3791	Not significant
Living donor	52 (89.7)	33 (97.1)	19 (95.0)
Deceased donor	6 (10.3)	1 (2.9)	1 (5.0)
DSA and HLA matching
HLA mismatches, median (IQR)	8.0 (6.2-10.0)	6.0 (5.0-7.0)	7.0 (5.0-9.0)	0.0000	Significant
DSA type	Class I + II, 58 (100.0)	Class II only, 34 (100.0)	Class I, 19 (95.0), Class II, 1 (5.0)	-	Not tested
Number of DSAs, median (IQR)	5.0 (2.0-7.8)	3.0 (2.0-6.0)	1.0 (1.0-2.2)	0.0005	Significant
Cumulative DSA strength (MFI), median (IQR)	3811.0 (2366.5-6998.8)	2277.0 (1213.8-3900.8)	686.5 (612.5-857.5)	0.0000	Significant
Treatment and sensitization
Sensitizing events
Sensitized	5 (8.6)	3 (8.8)	1 (5.0)	1.0000	Not significant
Not sensitized	53 (91.4)	31 (91.2)	19 (95.0)	1.0000	Not significant
Induction therapy
ATG	58 (100.0)	31 (91.2)	19 (95.0)	0.0825	Borderline
Basiliximab	0 (0.0)	3 (8.8)	1 (5.0)	0.0825	Borderline
Maintenance therapy
FK MMF PRED	57 (98.3)	34 (100.0)	20 (100.0)	0.6252	Not significant
CSA MMF PRED	1 (1.7)	0 (0.0)	0 (0.0)	0.6252	Not significant
Diabetes pre-transplant
Yes	27 (46.6)	18 (52.9)	7 (35.0)	0.4426	Not significant
No	31 (53.4)	16 (47.1)	13 (65.0)	0.4426	Not significant
Previous transplant
Yes	2 (3.4)	0 (0.0)	1 (5.0)	-	Not tested
No	56 (96.6)	4 (100.0)	19 (95.0)	-	Not tested
IVIG use
Yes	40 (69.0)	19 (55.9)	8 (40.0)	0.0637	Borderline
No	18 (31.0)	15 (44.1)	12 (60.0)	0.0637	Borderline
ATG dose	5.0 (4.0-5.0)	5.0 (4.0-5.0)	5.0 (4.0-5.0)	0.7762	Not significant
Graft function and outcomes
Acute rejection
Yes	4 (6.9)	0 (0.0)	1 (5.0)	0.3002	Not significant
No	54 (93.1)	20 (100.0)	19 (95.0)	0.3002	Not significant
Graft loss
Yes	4 (6.9)	2 (5.9)	0 (0.0)	0.4912	Not significant
No	54 (93.1)	32 (94.1)	20 (100.0)	0.4912	Not significant
Delayed graft function				0.5298	Not significant
Yes	2 (3.4)	2 (5.9)	0 (0.0)
No	56 (96.6)	32 (94.1)	20 (100.0)
Death (mortality)
Yes	3 (5.2)	2 (5.9)	0 (0.0)	0.5590	Not significant
No	55 (94.8)	32 (94.1)	20 (100.0)
CMV infection
Yes	2 (3.4)	1 (2.9)	0 (0.0)	0.7078	Not significant
No	56 (96.6)	19 (97.1)	20 (100.0)	0.7078	Not significant
BKV infection
Yes	1 (1.8)	1 (3.3)	0 (0.0)	-	Not tested
No	54 (98.2)	29 (96.7)	19 (100.0)	-	Not tested
Length of stay (days)	9.0 (8.0-12.0)	10.0 (8.0-11.0)	9.0 (7.0-12.5)	0.9692	Not significant
Creatinine at 4 months (µmol/L)	94.0 (76.0-114.0)	88.0 (70.5-110.8)	77.5 (69.8-103.8)	0.4911	Not significant
eGFR at 4 months (mL/minute/1.73 m²)	76.0 (64.0-88.0)	78.0 (59.5-97.5)	92.0 (66.2-109.5)	0.3234	Not significant

P value < 0.05 was considered statistically significant. Continuous variables were analyzed using the Kruskal-Wallis test, and categorical variables were assessed using the χ² test as appropriate, based on expected cell counts. DSA: Donor-specific antibody; HLA: Human leukocyte antigen; ATG: Anti-thymocyte globulin; FK: Tacrolimus; MMF: Mycophenolate mofetil; CSA: Cyclosporine A; PRED: Prednisolone; IVIG: Intravenous immunoglobulin; eGFR: Estimated glomerular filtration rate; MFI: Mean fluorescence intensity; CMV: Cytomegalovirus; IQR: Interquartile range; BKV: BK virus.

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Citation: Al-Qurashi SH, Khalil MAM, Mahmood HHK, Alsharif MM, Alqurashi YF, Alghamdi L, Al-Ghamdi RA, Alsaedi ZA, Cruz AJD, Aboasamh GA, Sadagah NM. Immunologic clustering of donor-specific antibodies and clinical outcomes in kidney transplant recipients. World J Transplant 2026; 16(2): 118450
URL: https://www.wjgnet.com/2220-3230/full/v16/i2/118450.htm
DOI: https://dx.doi.org/10.5500/wjt.v16.i2.118450

Al-Qurashi SH, Khalil MAM, Mahmood HHK, Alsharif MM, Alqurashi YF, Alghamdi L, Al-Ghamdi RA, Alsaedi ZA, Cruz AJD, Aboasamh GA, Sadagah NM. Immunologic clustering of donor-specific antibodies and clinical outcomes in kidney transplant recipients. World J Transplant 2026; 16(2): 118450 [PMID: 42281880 DOI: 10.5500/wjt.v16.i2.118450]

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