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Abstract: FR-PO887

Comparison of Banff Allograft Injury Scores of Patients with De Novo Donor-Specific Antibodies (DSAs) to Patients with Preformed DSAs

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical


  • Ajaimy, Maria, Montefiore Medical Center, Bronx, New York, United States
  • Colovai, Adriana, Montefiore Medical Center, Bronx, New York, United States
  • Hayde, Nicole A., Montefiore Medical Center, Bronx, New York, United States
  • Akalin, Enver, Montefiore Medical Center, Bronx, New York, United States

We aimed to compare histological features of rejection in patients with preformed and de novo DSAs and its association with clinical outcomes


This is a prospective study including 681 non-HLA-identical patients who received a kidney tx between 1/2009 and 12/ 2014 at our center. Protocol testing for DSA via LABScreen single antigen beads was done before and at 1, 3, 12 months, and then annually after kidney tx or when clinically indicated. Tx kidney biopsies are performed as clinically indicated


114 (17%) patients had preformed DSA. During a median 3.8 (2.4-5.3) years of follow-up, de novo DSA developed in 92 patients (13%) at a median of 1.24(0.71-2.35) years after kidney tx. While there was no difference in patient survival, de novo DSA group had significantly lower graft survival (63.8% vs. 88.6%, P<0.001), higher antibody-mediated rejection (ABMR) (13.04% vs. 6.14%, p=0.001), transplant glomerulopathy (16.6% vs. 9% vs. 4.7%, P=0.004) and T cell mediated rejection (14.13%vs. 2.63%, p=0.001) compared to patients with preformed DSA. ABMR developed at a median 0.39 years (0.13-1.4) in pre-transplant DSA patients and at 1.25 years (0.25-3.31) in de novo DSA ones. When comparing the Banff allograft injury scores in 16 pre DSA and 34 de novo DSA biopsies, mean total acute Banff allograft injury score (g+ i+t+ptc+v, 6.29±3.57 vs. 4.19±3.39, p=0.046) was statistically significantly higher in the de novo DSA. The rest of acute and chronic allograft injury scores were not significantly different


Development of de novo DSA after kidney tx is associated with higher total acute allograft injury score, rejection episodes, and lower allograft survival compared to preformed DSA.

Banff Scores
 Pre Transplant DSADe novo DSAP
g(mean, SD)0.52±0.770.51±0.760.87
t(mean, SD)0.57±0.691.11±1.150.14
v(mean, SD)0.15±0.370.18±0.390.86
g+i+t+ptc+v(mean, SD)4.19±3.396.29±3.570.046
ct(mean, SD)1.26±0.991.00±0.890.36
ci(mean, SD)1.05±0.970.74±0.870.24
cv(mean, SD)0.31±0.470.39±0.620.84
ct+ci+cv(mean, SD)7.31±3.308.71±4.710.30
c4d(mean, SD)1.05±1.391.16±1.280.74