Detection of Complement-Binding Donor-Specific Antibodies, not IgG-Antibody Strength nor C4d Status, at Antibody-Mediated Rejection Diagnosis is an Independent Predictor of Kidney Graft Failure

Background Antibody-mediated rejection (ABMR) remains associated with reduced kidney graft survival and no clear prognostic marker is available. Methods We investigated whether donor-specific antibodies (DSA) ability to bind C1q in comparison with ABMR C4d status, both indirect signs of complement activation, improve risk stratification at time of ABMR. Hence, among 467 patients in whom ≥1 graft biopsy was performed between 2008 and 2015, we included 56 with ABMR according to Banff'15 criteria. Using concurrent sera, we prospectively identified DSA by single-antigen beads (IgG and C1q) assays. Results ABMR C4d (+) (n=28) was associated with preformed DSA (P=0.007), while DSA C1q (+) (n=25) cases had stronger IgG-DSA (P

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