Impact of pretransplant donor-specific antibodies and human leukocyte antigen mismatches on graft and patient outcomes: A cohort from Saudi Arabia

Table 4 Univariate analysis of factors associated with acute rejection after kidney transplantation, n (%)/median (interquartile range)

Group and variable	AR-negative	AR-positive	Univariate
Recipient
Age	43.5 [31.2-60.0]	40.0 [30.8-45.2]	0.2584
Recipient gender			0.3243
Male	147 (58.8)	8 (80.0)
Female	103 (41.2)	2 (20.0)
Donor
Donor age	33.5 [28.0-42.0]	34.5 [31.2-36.8]	0.8586
Donor gender			0.7296
Male	172 (68.8)	6 (60.0)
Female	78 (31.2)	4 (40.0)
Donor type			0.5936
Living donor	229 (91.6)	9 (90.0)
Deceased donor	21 (8.4)	1 (10.0)
DSA & HLA matching
HLA mismatches	6.0 [5.0-8.0]	9.0 [7.2-9.0]	0.0048
DSA presence			0.5274
Yes	144 (57.6)	7 (70.0)
No	106 (42.4)	3 (30.0)
DSA strength			1.0000
< 1000 MFI	68 (47.2)	3 (42.9)
≥ 1000 MFI	76 (52.8)	4 (57.1)
DSA type			0.3598
Class I only	29 (20.1)	1 (14.3)
Class II only	51 (35.4)	1 (14.3)
Both	64 (44.4)	5 (71.4)
Number of DSAs	3.0 [2.0-6.0]	1.0 [1.0-2.0]	0.0698
Cumulative MFI	2205.0 [901.2-4195.0]	2010.0 [1191.5-5216.5]	0.9330
Treatment & sensitization
ATG dose	4.0 [4.0-5.0]	4.0 [4.0-6.0]	0.4704
Sensitizing events			0.0378
Yes	15 (6.1)	2 (18.2)
No	234 (93.9)	9 (81.8)
Induction therapy			0.6758
ATG-based	206 (82.4)	8 (80.0)
Basiliximab-based	41 (16.4)	2 (20.0)
Mixed	3 (1.2)	0 (0.0)
Maintenance therapy			1.0000
FK MMF ST	246 (98.4)	10 (100.0)
CSA MMF ST	4 (1.6)	0 (0.0)
Use of IVIG			0.1764
Yes	88 (35.3)	6 (60.0)
No	161 (64.7)	4 (40.0)
Previous transplant			1.0000
Yes	4 (1.6)	0 (0.0)
No	245 (98.4)	10 (100.0)
Pre-transplant diabetes			0.7463
Yes	104 (41.6)	5 (50.0)
No	146 (58.4)	5 (50.0)
Graft function & outcomes
Graft loss			0.0076
Yes	9 (3.6)	3 (30.0)
No	241 (96.4)	7 (70.0)
DGF			0.0716
Yes	10 (4.0)	2 (20.0)
No	240 (96.0)	8 (80.0)
Mortality			0.2725
Yes	7 (2.8)	1 (10.0)
No	243 (97.2)	9 (90.0)
CMV infection			1.0000
Yes	5 (2.0)	0 (0.0)
No	245 (98.0)	10 (100.0)
BKV infection			1.0000
Yes	5 (2.2)	0 (0.0)
No	225 (97.8)	9 (100.0)
Length of stay (days)	9.0 [8.0-12.0]	8.0 [7.0-9.0]	0.1376
Creatinine - 4 months	92.0 [73.0-112.0]	136.5 [106.5-148.0]	0.0217
Creatinine - 1 year	89.0 [73.0-109.0]	122.0 [95.0-126.0]	0.0649
Creatinine - 2 year	89.5 [71.8-104.5]	118.0 [79.2-129.8]	0.2531
eGFR - 4 months	80.0 [64.5-95.0]	57.5 [51.5-87.2]	0.1032
eGFR - 1 year	83.0 [66.8-98.0]	69.0 [62.0-93.0]	0.3210
eGFR - 2 years	85.0 [72.0-97.0]	75.5 [68.8-84.5]	0.4011
Class I antibody profile
Anti-A presence			0.6287
Yes	33 (13.2)	2 (20.0)
No	217 (86.8)	8 (80.0)
Anti-B presence			1.0000
Yes	25 (10.0)	1 (10.0)
No	225 (90.0)	9 (90.0)
Anti-C presence			0.2936
Yes	76 (30.4)	5 (50.0)
No	174 (69.6)	5 (50.0)
Class II antibody profile
Anti-DR presence			0.3975
Yes	80 (32.0)	5 (50.0)
No	170 (68.0)	5 (50.0)
Anti-DP presence			1.0000
Yes	52 (20.8)	2 (20.0)
No	198 (79.2)	8 (80.0)
Anti-DQ presence			0.7317
Yes	67 (26.8)	3 (30.0)
No	183 (73.2)	7 (70.0)

The Mann-Whitney U test was used for continuous variables, and the χ² or Fisher’s exact test was applied for categorical variables, depending on cell sizes. Statistical significance was defined as P < 0.05. AR: Acute rejection; ATG: Antithymocyte globulin; BKV: BK virus; CMV: Cytomegalovirus; CSA: Cyclosporine; DGF: Delayed graft function; DSA: Donor-specific antibody; eGFR: Estimated glomerular filtration rate; FK: Tacrolimus; HLA: Human leukocyte antigen; IQR: Interquartile range; IVIG: Intravenous immunoglobulin; MFI: Mean fluorescence intensity; MMF: Mycophenolate mofetil; OR: Odds ratio; Pred: Prednisolone; ST: Steroid; TCMR: T cell-mediated rejection.