Abstract: SA-PO468

Differential Outcomes in Patients with De Novo Donor-Specific Antibodies (DSA) Compared to Patients with Preformed DSAs

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Ajaimy, Maria, Montefiore Medical Center, Bronx, New York, United States
  • Colovai, Adriana, Montefiore Medical Center, Bronx, New York, United States
  • Hayde, Nicole A., None, Bronx, New York, United States
  • Akalin, Enver, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
Background

We aimed to investigate the prevalence and dynamic changes of preformed and de novo DSAs after kidney transplantation and its association with clinical outcomes

Methods

This is a prospective study including 664 non-HLA-identical patients who received a kidney transplant between January 2009 and December 2014. Protocol testing for DSA via LABScreen single antigen beads was done before and at 1, 3, 12 months, and then annually. Patients with preformed DSAs received a transplant with anti-thymocyte globulin and IVIG induction treatment if CDC cross-match was negative and MFI value was < 5,000 for HLA-A, B, DR and < 10,000 for HLA-C, DQ and DP.

Results

108 (16%) patients had preformed DSA before transplantation. During a median 3.8 (2.4-5.3) years of follow-up, de novo DSA developed in 95 patients (17%) at a mean of 20.3±13.3 months after transplantation. Those patients were compared to 461 patients without any DSA. There was no difference between incidences of acute antibody(AMR) or T cell mediated rejection(ACR), chronic rejection, transplant glomerulopathy(TG), serum creatinine levels, graft and patient survival when preformed DSA patients compared to no DSA patients. While there was no significant difference in patient survival, de novo DSA group had lower graft survival (64.1% vs. 92.7%), higher AMR (17.3% vs. 1.6%), ACR (14.1 vs. 4.3%) and TG/CAMR (16.3% vs. 3.3%). Of the 108 patients with preformed DSA, 67 patients lost DSA and 41 showed persistent DSA. Persistent DSA patients had more class II antibodies (56% vs. 36%) and higher MFI values (4608+/-4150 vs. 2325+/-1283). For de novo DSA patients, 49% had persistent DSA, 40% lost their DSA and 11% had their DSA MFI decreased by more than 50%. The mean sum MFI of de novo DSA in the persistent group (9562.8±9409.1) was higher than the patients who lost their DSAs (4063.9±3487) or DSA MFI decreased by more than 50% (8768.7±4854.5).

Conclusion

17% of our transplant recipients develop de novo DSA after kidney transplantation and associated with significantly higher acute and chronic rejection and lower allograft survival. Low leveL pre-tx DSA does not increase the risk of graft loss in patients who receive thymoglobulin/IVIG induction therapy