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                <title level="j">Transplantation</title>
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              <p>BACKGROUND:De novo donor-specific antibodies (DSA) are associated with antibody-mediated rejection (AMR) and allograft loss. Whether monitoring of de novo DSA (dnDSA) paired with systematic kidney biopsy should become routine remains to be established.METHODS:A retrospective multicentric study (9 French kidney transplant units of the Spiesser Group) included patients without graft dysfunction biopsied because of the presence of de novo DSA (One Lambda, MFI &gt; 1000).RESULTS:123 patients (85M/38F; mean age: 49.5 ± 13.1 years old) were biopsied after the detection of a dn DSA, 65.3 months (median) after kidney transplantation. Graft function was stable within 3 months before biopsy (estimated glomerular filtration rate (eGFR): 55.3 ± 18.9 ml/min/1.73m²). Fifty-one subclinical AMR (sAMR) (41.4%) were diagnosed, of which 32 (26%) active and 19 (15.5%) chronic active sAMR. Seventy-two biopsies revealed no AMR (58.5%). Predictive factors associated with the diagnosis of active sAMR were MFI of immunodominant DSA &gt; 4000, MFI of the sum of DSA &gt; 6300, age of the recipient &lt; 45 y, and the absence of steroids at biopsy. The presence of proteinuria &gt; 200 mg/g was predictive of chronic active sAMR. The decrease of eGFR at 5 years post biopsy was significantly higher in patients with acute sAMR (-25.2 ± 28.3 mL/min/1.73m²) and graft survival significantly lower.CONCLUSION:Performing a kidney graft biopsy for the occurrence of dnDSA without renal dysfunction leads to the diagnosis of a sAMR in over 40% of cases. Neverthess, we did not observe any effect of standard treatment in acute sAMR.</p>
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              <addrLine>Hôpital de la Cavale Blanche, Boulevard TANGUY PRIGENT - 29200 BREST</addrLine>
              <country key="FR"/>
            </address>
          </desc>
          <listRelation>
            <relation active="#struct-356603" type="direct"/>
          </listRelation>
        </org>
        <org type="institution" xml:id="struct-300170" status="VALID">
          <idno type="ROR">https://ror.org/029s6hd13</idno>
          <orgName>Centre hospitalier universitaire de Poitiers = Poitiers University Hospital</orgName>
          <orgName type="acronym">CHU de Poitiers [La Milétrie]</orgName>
          <desc>
            <address>
              <addrLine>2 rue de la Milétrie – 86000 Poitiers – France</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.chu-poitiers.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-426102" status="VALID">
          <orgName>Établissement Français du Sang Normandie [Rouen]</orgName>
          <orgName type="acronym">EFS Normandie - Rouen</orgName>
          <desc>
            <address>
              <addrLine>Site de Rouen. 1 Rue de Germont 76000 Rouen</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.efs.sante.fr/lefs-en-hauts-de-france-et-normandie</ref>
          </desc>
          <listRelation>
            <relation active="#struct-199980" type="direct"/>
          </listRelation>
        </org>
        <org type="regroupinstitution" xml:id="struct-455934" status="VALID">
          <idno type="IdRef">190906332</idno>
          <idno type="ISNI">0000000417859671 </idno>
          <idno type="ROR">https://ror.org/01k40cz91</idno>
          <orgName>Normandie Université</orgName>
          <orgName type="acronym">NU</orgName>
          <date type="start">2015-01-01</date>
          <desc>
            <address>
              <addrLine>Esplanade de la Paix - CS 14032 - 14032 Caen Cedex 5</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.normandie-univ.fr/</ref>
          </desc>
        </org>
        <org type="regroupinstitution" xml:id="struct-211628" status="VALID">
          <idno type="IdRef">030378842</idno>
          <idno type="ROR">https://ror.org/04bckew43</idno>
          <orgName>Hôpitaux Universitaires de Strasbourg</orgName>
          <orgName type="acronym">HUS</orgName>
          <desc>
            <address>
              <addrLine>1 place de l'hôpital BP 426 67091 Strasbourg cedex</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.chru-strasbourg.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-356603" status="VALID">
          <orgName>Centre Hospitalier Régional Universitaire de Brest</orgName>
          <orgName type="acronym">CHRU Brest</orgName>
          <desc>
            <address>
              <country key="FR"/>
            </address>
          </desc>
        </org>
        <org type="regroupinstitution" xml:id="struct-199980" status="VALID">
          <orgName>Établissement Français du Sang [La Plaine Saint-Denis]</orgName>
          <orgName type="acronym">EFS</orgName>
          <date type="start">2000-01-01</date>
          <desc>
            <address>
              <addrLine>20 Avenue du Stade de France 93218 La Plaine Saint Denis</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.dondusang.net</ref>
          </desc>
        </org>
      </listOrg>
    </back>
  </text>
</TEI>