{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T01:57:49Z","timestamp":1789091869893,"version":"build-2803163510"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T00:00:00Z","timestamp":1688601600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Valdecilla Biomedical Research Institute"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,20]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>De novo donor-specific antibodies (dnDSAs) may cause antibody-mediated rejection and graft dysfunction. Little is known about the clinical course after first detection of dnDSAs during screening in asymptomatic patients. We aimed to assess the value of estimated glomerular filtration rate (eGFR) and proteinuria to predict graft failure in patients with dnDSAs and their potential utility as surrogate endpoints.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All 400 kidney transplant recipients with dnDSAs at our centre (1 March 2000\u201331 May 2021) were included in this retrospective study. The dates of graft loss, rejection, doubling of creatinine, \u226530% eGFR decline, proteinuria \u2265500\u00a0mg\/g and \u22651000\u00a0mg\/g were registered from the first dnDSA appearance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During 8.3\u00a0years of follow-up, graft failure occurred in 33.3% of patients. Baseline eGFR and proteinuria correlated with 5-year graft loss (area under the receiver operating characteristics curve 0.75 and 0.80, P\u00a0&amp;lt;\u00a0.001). Creatinine doubled after a median of 2.8\u00a0years [interquartile range (IQR) 1.5\u20135.0] from dnDSA and the time from doubling creatinine to graft failure was 1.0\u00a0year (IQR 0.4\u20132.9). Analysing eGFR reduction \u226530% as a surrogate endpoint (148\/400), the time from dnDSA to this event was 2.0\u00a0years (IQR 0.6\u20134.2), with a positive predictive value (PPV) of 45.9% to predict graft loss, which occurred after 2.0\u00a0years (IQR 0.8\u20133.2). The median time from proteinuria \u2265500\u00a0mg\/g and \u22651000\u00a0mg\/g to graft failure was identical, 1.8\u00a0years, with a PPV of 43.8% and 49.0%, respectively. Composite endpoints did not improve PPV. Multivariable analysis showed that rejection was the most important independent risk factor for all renal endpoints and graft loss.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Renal function, proteinuria and rejection are strongly associated with graft failure in patients with dnDSA and may serve as surrogate endpoints.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ndt\/gfad149","type":"journal-article","created":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T16:37:33Z","timestamp":1688661453000},"page":"84-94","source":"Crossref","is-referenced-by-count":6,"title":["Predictors of graft failure after first detection of <i>de novo<\/i> donor-specific HLA antibodies in kidney transplant recipients"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0613-2595","authenticated-orcid":false,"given":"Covadonga","family":"L\u00f3pez del Moral","sequence":"first","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"},{"name":"Department of Nephrology, Marqu\u00e9s de Valdecilla University Hospital-IDIVAL , Santander , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiyin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6063-2806","authenticated-orcid":false,"given":"Marcel","family":"Naik","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilgin","family":"Osmanodja","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aylin","family":"Akifova","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Lachmann","sequence":"additional","affiliation":[{"name":"Institute for Transfusion Medicine, HLA-Laboratory, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Stauch","sequence":"additional","affiliation":[{"name":"Institute for Transfusion Medicine, HLA-Laboratory, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Hergovits","sequence":"additional","affiliation":[{"name":"Institute for Transfusion Medicine, HLA-Laboratory, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike","family":"Bachmann","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Halleck","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Schrezenmeier","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"},{"name":"Berlin Institute of Health Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, BIH Academy , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7929-5942","authenticated-orcid":false,"given":"Klemens","family":"Budde","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin , 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