Kidney Week

Abstract: SA-PO1169

Association Between Post-Transplant Donor-Specific Antibodies and Recipient Outcomes in Simultaneous Liver-Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Yazawa, Masahiko, University of Tennessee Health Science Center, Memphis, United States

Masahiko Yazawa,

• Cseprekál, Orsolya, Semmelweis University, Budapest, Hungary

Orsolya Cseprekál,

• Helmick, Ryan A., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Ryan A. Helmick,

• Talwar, Manish, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Manish Talwar,

• Balaraman, Vasanthi, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Vasanthi Balaraman,

• Podila, Pradeep S b, Methodist Le Bonheur Healthcare, Memphis, Tennessee, United States

Pradeep S b Podila,

• Agbim, Uchenna, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Uchenna Agbim,

• Fossey, Sallyanne, DCI, Inc, Nashville, Tennessee, United States

Sallyanne Fossey,

• Satapathy, Sanjaya K., Northshore University Hospital/Northwell Health, Manhasset, New York, United States

Sanjaya K. Satapathy,

• Sumida, Keiichi, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Eason, James D., University of Tennessee Health Science Center, Memphis, Tennessee, United States

James D. Eason,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

Group or Team Name

• METEOR (MEthodist Transplant EpidemiOlogy Research) Group

Background

There is a dearth of published data regarding the presence of post-transplant Donor Specific Antibodies (DSA), especially C1q binding DSA (C1q+DSA), and patient and kidney allograft outcomes in simultaneous liver-kidney transplant (SLKT) recipients.

Methods

We investigated 85 consecutive patients who underwent SLKT between 2009-2018 in our center. Associations between presence of post-transplant DSA [persistent and/or newly developed (de novo)] and C1q+DSA, and all-cause mortality and the composite outcome (mortality, allograft kidney loss, and antibody-mediated rejection) were examined using unadjusted and age and sex-adjusted Cox proportional hazards regression models.

Results

The mean age at transplantation was 56 years. Sixty and 26% of the patients were male and African-American, respectively. Twelve patients (14%) had post-transplant DSA and 7 (8%) patients had C1q+DSA. The presence of post-transplant DSA was significantly associated with increased risk of mortality (unadjusted model: Hazard Ratio (HR)=2.72, 95%Confidence Interval (CI): 1.06-6.98 and adjusted model: HR=3.20, 95%CI: 1.11-9.22) and the composite outcome (unadjusted model: HR=3.18, 95%CI: 1.31-7.68 and adjusted model: HR=3.93, 95%CI: 1.39-11.10) compared to the DSA negative group (Figure). There was no significant association between the presence of C1q+DSA and outcomes (adjusted model: HR=1.67, 95%CI: 0.43-6.45 for mortality, and HR=2.61, 95%CI: 0.70-9.75 for the composite outcome).

Conclusion

The presence of post-transplant DSA was significantly associated with increased risk of all-cause mortality and composite outcome including kidney allograft loss and ABMR. The presence of post-transplant DSA should not be ignored in routine patient care after SLKT even though pre-transplant sensitized status is usually neglected at the time of SLKT.