DOI: 10.1101/460030Nov 1, 2018Paper

A Pre-transplant Blood-based Lipid Signature for Prediction of Antibody-mediated Rejection in Kidney Transplant Patients

BioRxiv : the Preprint Server for Biology
Gaurav GuptaDayanjan Shanaka Wijesinghe


There is a lack of biomarkers for pre-kidney transplant immune risk stratification to avoid over- or under-immunosuppression. Since the circulating lipidome is integrally involved in inflammation, we hypothesized that the lipidome may provide biomarkers that are helpful in the prediction of antibody-mediated rejection. We used mass spectrometry to detect the plasma lipidome in samples collected over 1 year post-kidney transplant from a prospective, observational cohort of adult kidney transplant recipients (KTR), classified in two groups, one with antibody mediated rejection (AMR) and the other with stable graft function (SC). We used linear discriminant analysis to generate predictive models of rejection. A lipid-only model generated from samples taken on day of transplant (T1) revealed a seven lipid classifier (lysophosphatidylethanolamine and phosphatidylcholine species) with misclassification rate of 8.9% [AUC = 0.95 (95% CI = 0.84-0.98), R2 = 0.63]. A clinical model [(using donor specific antibody (DSA) and panel reactive antibody (PRA)] was inferior with a misclassification rate of 15.6% [AUC = 0.82 (95% CI = 0.69-0.93), R2 = 0.41]. A combined model using four lipid classifiers and DSA improved the AUC further to 0.98 (95...Continue Reading

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