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De Novo DSA Prognostic Significance — ESENeph MCQ

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HardTransplantationDe Novo DSA Prognostic SignificanceESENeph

Routine surveillance detects new donor-specific HLA antibodies 18 months after kidney transplantation. Creatinine and proteinuria are unchanged. What is the best next strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Adherence and exposure optimisation followed by allograft biopsy

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as E

A is correct. De novo DSA is a risk marker even with stable creatinine, but antibody characteristics alone cannot diagnose the graft lesion. ESOT recommends optimisation of adherence and maintenance immunosuppression and regards biopsy as the best way to identify subclinical antibody-mediated or T-cell-mediated rejection before additional treatment. B exposes an unphenotyped patient to intensive therapy. C delays potentially important assessment. D weakens protection. E gives one laboratory characteristic authority it does not have. Management after biopsy depends on histology, chronicity, antibody evolution, drug exposure and the balance between rejection and infection risk.

Reference: ESOT consensus on post-transplant donor-specific antibody monitoring: https://pmc.ncbi.nlm.nih.gov/articles/PMC10408721/