Impact of alloantibody strength in crossmatch negative DSA positive kidney transplantation

The pre-formed anti-HLA donor-specific alloantibodies (DSAs) were associated with AMR at multiple mean fluorescence intensity (MFI) cutoffs even as low as 500 cutoffs. There was an increased risk of AMR with higher levels of pre-transplant DSA. No correlation was seen between acute T-cell mediated rejection (CMR) and pre-transplant DSA at any of the same MFI cutoffs. An increase in DSA MFI from pre- to two weeks post-transplant was indicative of a higher probability of AMR indicating the association between low-level pre-transplant HLA-DSA (detected by SAFB) with AMR and the importance of monitoring DSA post-transplant.