Abstract: SA-PO522

Association of Pre-Transplant Anti-LG3 Autoantibodies and Delayed Graft Function in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Mawad, Habib, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
  • Boucquemont, Julie, Research Institute McGill Univ. Health Centre, Montreal, Quebec, Canada
  • Foster, Bethany J., McGill University Health Center, Montreal, Quebec, Canada
  • Cardinal, Heloise, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
Background

Pre-transplant antibodies to the LG3 fragment of perlecan (anti-LG3) are associated with an increased risk of delayed graft function (DGF) in kidney transplant recipients (KTR). Factors that increase susceptibility of the allograft to the deleterious effects of pre-transplant anti-LG3 antibodies have not been characterized. The aims of this study were to validate the association between pre-transplant anti-LG3 titers and DGF and to assess if this relationship is modified by longer ischemia or donor type.

Methods

We performed a retrospective cohort study in 2 Canadian adult kidney transplant centers. All consecutive KTR were recruited between June 1st, 2008 and July 20th, 2014. The primary outcome was DGF, defined as the need for dialysis within the first week after transplantation, failure of serum creatinine to decrease by more than 10% on the first 3 post-operative days, or serum creatinine >250 umol/L on post-operative day 5 in the presence of scintigraphic evidence of acute tubular necrosis. The main independent variable was pre-transplant anti-LG3 titers, measured with a locally-developed ELISA. Anti-LG3 >225 U/mL were considered positive. The interaction variables were ischemic time and donor type. Total ischemic time was dichotomized at the top quartile (15h). Donor type was classified as extended-criteria or deceased after cardiac-arrest vs. all other donor types.

Results

Among the 442 study subjects, 163 (37%) developed DGF. In multivariate analyses adjusted for donor type and ischemic time, positive anti-LG3 titers were associated with the occurrence of DGF (odds ratio (OR) 1.90, 95% confidence interval (CI) 1.18-3.07). The point estimates for the association between anti-LG3 and DGF were higher when total ischemic time was >15h (OR 2.51, 95% CI 0.89-7.78) vs. ≤15h (OR 1.80, 95% CI 1.07-3.00), but the interaction was not statistically significant. Similarly, the OR was higher for transplants from extended-criteria donors/donors after cardiac-arrest (OR 2.25, 95% CI 0.97-5.61) vs. other recipients (OR 1.60, 95% CI 0.90-2.78), but the interaction was not significant.

Conclusion

These results confirm that anti-LG3 are independently associated with DGF. Larger studies are needed to determine if ischemia and extended criteria donors/donors after cardiac arrest enhance the association between anti-LG3 and DGF.