Abstract: SA-PO477
Evaluation of C1q status and Titre of Donor Specific Antibodies as Predictors of Allograft Survival
Session Information
- Transplantation: Balancing Rejection and Infection
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Attia, Osama, Zagazig university hospital, Zagazig, Zagazig, Egypt
- White, Emma, Royal London Hospital, London, United Kingdom
- Kallon, Delordson, Royal London Hospital, London, United Kingdom
- Gupta, Arun, Royal London Hospital, London, United Kingdom
- Ashman, Neil, Royal London hospital, London, London, United Kingdom
- Yaqoob, Muhammad M., William Harvey Research Institute, London, United Kingdom
Background
Donor-specific antibodies (DSA) either developed as de-novo or formed before renal transplantation are independent predictors of allograft loss. However, it is unknown if DSA and DSA C1q status post transplantation can independently predict allograft loss. Serologically emergence of de-novo or rising titres of preformed DSA is used as surrogate markers of impending graft dysfunction and rejection. However sensitivity and specificity of this approach is not robust enough to escalate immunosuppression. However recent evidence suggests that complement binding DSA may identify clinically relevant anti-allograft antibodies
Methods
600 patients received either a deceased or live donor kidney transplant between January 2008 and June 2015 after negative CDC cross match. All patients received standard immunosuppression as per departmental protocol. 42 patients with either persistent or de-novo DSA between 3-28 months post transplantation were studied retrospectively.C1q fixing DSA were studied using single Ag luminex technique with MFI more than 5000 was detected as positive.
Results
19 patients were positive for C1q status. 60% graft developed rejection and 43% of the grafts were lost in the entire cohort predominantly within the two years of positivity. C1q positive status compared to negative did not differentiate between rate and type of rejection (68% vs 52% p=1.14). Rejection within three months of C1q positivity were significantly higher (63% vs 33% p=0.034). However, significantly greater grafts were lost with C1q positivity compared to C1q negative (63% vs 35% p < 0.05) despite receiving similar antirejection therapy.
Conclusion
We conclude that C1q binding DSA post transplantation is associated with rejection if tested within three months of biopsy for graft dysfunction. More importantly It is also associated with poor graft survival. C1q status may help clinician in the identification of patients who may be at high of losing graft following rejection and help in optimization of immusuppression therapy.
Funding
- Government Support - Non-U.S.