Kidney Week

Abstract: SA-PO466

Kidney Transplantation across Strong Donor-Specific HLA-DP Antibodies

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

• Ahearn, Patrick, UCSF, San Francisco, California, United States

Patrick Ahearn,

• Webber, Allison B., UCSF, San Francisco, California, United States

Allison B. Webber,

• Cunniffe, Kelly J, UCSF, San Francisco, California, United States

Kelly J Cunniffe,

• Gae, David, UCSF, San Francisco, California, United States

David Gae,

• Tavakol, Matthew Mehdi, UCSF, San Francisco, California, United States

Matthew Mehdi Tavakol,

• Roll, Garrett, UCSF, San Francisco, California, United States

Garrett Roll,

• Da Gente, Gilberto, UCSF, San Francisco, California, United States

Gilberto Da Gente,

• Hirose, Ryutaro, UCSF, San Francisco, California, United States

Ryutaro Hirose,

• Roberts, John, UCSF, San Francisco, California, United States

John Roberts,

• Raja, Rajalingam, UCSF, San Francisco, California, United States

Rajalingam Raja,

Background

Patients (pts) awaiting kidney transplant (ktx) with pre-formed donor specific anti-HLA antibodies (DSA) have been subjected to aggressive desensitization or long wait times for a compatible donor. Anti-DP DSA may represent a unique situation amenable to ktx without desensitization. Since 2014, we have done 16 ktx with isolated pre-formed anti-DP DSA with Mean Fluorescence Intensity (MFI) >5000 without desensitization.

Methods

We performed a chart review to assess the incidence of antibody mediated rejection (AMR) and graft survival at 6 months post ktx in this pt population.

Results

16 pts with DP DSA >5,000 MFI and cPRA ranging from 75-100% underwent ktx. All pts have completed 6 month follow up. Virtual crossmatch was used in all pts; 8 had a positive B cell flow crossmatch. All pts received 2 g/kg IVIG in the immediate post- ktx period. There was a significant decrease in DP DSA MFI (figure). During six month follow up period,14 pts had allograft biopsy. Six pts were diagnosed with AMR. There was no graft loss. Mean eGFR (MDRD equation) at 6 months was (63.9 ml/min). eGFR for the 10 patients without AMR was 71.5 ml/min versus 43.1 ml/min in those patients with AMR (P=0.02). There was no difference between those with AMR vs no AMR wrt sex (P=0.12), race (P=0.28), cPRA (P= 0.65), or positive flow x match (P=1). Pts with AMR were younger (P=0.03) and displayed a trend toward higher pre-ktx DP DSA MFI compared to those without AMR (16897 vs 11719, P= 0.16).

Conclusion

We have been successfully transplanting pts with high levels of DP DSA (even with positive FXM) without aggressive desensitization. At 6 months, 10 out of 16 patients with anti DP DSA MFI >5000 experienced no AMR and there was no graft loss. Further investigation is needed to identify definitive risk factors for AMR in ktx with anti-DP DSA. Higher MFI pre-ktx may be a risk factor for AMR in this population and should be further investigated.