Impact of anti-mica antibodies on graft function, rejection, and survival in live-related renal transplant recipients: A prospective case-control study

Background

Non-HLA antibodies directed against major histocompatibility complex class I-related chain A (MICA) have been implicated in acute and chronic antibody-mediated rejection and in reduced graft survival after renal transplantation. Data on the clinical impact of anti-MICA antibodies, and of pre-transplant desensitisation in anti-MICA-positive recipients, remain limited, particularly from the Indian subcontinent. This study assessed the outcomes of anti-MICA antibody-positive live-related renal transplantation performed using a structured desensitisation protocol. Materials and Methods: This prospective case-control study was conducted at a tertiary-care transplant centre from March 2016 to March 2018 and included 50 live-related kidney transplant recipients who tested positive for anti-MICA antibodies, had a negative CDC crossmatch, and lacked donor-specific HLA class I/II antibodies (cases). These were compared to 50 recipients without anti-MICA antibodies (controls). All the Cases received desensitisation treatment with rituximab, plasma exchange (PLEX), and intravenous immunoglobulin (IVIg) before transplantation; controls did not undergo any desensitisation. Over a 6-month period, outcomes such as graft function (serum creatinine), biopsy-proven rejection, major infections, new-onset diabetes after transplantation (NODAT), graft failure, and mortality were evaluated.