Kidney Week

Abstract: SA-PO1147

Impact of Persistent and Transient Donor-Specific Antibodies Within First Year After Kidney Transplantation

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

• Sharma, Akhil, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Akhil Sharma,

• Jorgensen, Dana R., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Dana R. Jorgensen,

• Hariharan, Sundaram, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Sundaram Hariharan,

Background

The importance of Donor Specific Antibody (DSA) surveillance within 1^st year (yr) post kidney transplant remains unclear. We studied the impact of DSA pattern during the 1^st yr post-txp on clinical outcomes.

Methods

931 patients (pts) from 2013-17 were enrolled (HLA Compatible, Flow xmatch negative). Pts were grouped into Transient DSA (T-DSA, n=66; 1 positive test, Class I/II), Persistent DSA (P-DSA, n=115, >1 positive test, Class I/II), and No DSA (N-DSA, n=750) within 1^st yr post-txp. DSA testing was done @ 1,3,6,9, & 12 mos. Biopsies (protocol 3&12 mos, & indication) were included. Surrogate marker for this study included incidences of TCMR and ABMR. Outcomes measured were pt survival, graft survival and composite of pt loss, graft loss and eGFR <20ml/min at last follow-up.

Results

During the 1^st yr, DSA was detected in 19% of pts (7% T-DSA vs 12% P-DSA). There were no differences in baseline or txp characteristics, other than increased sensitization (cPRA>20%) in P-DSA pts (67% vs 47%, p=0.001). P-DSA pts developed DSA earlier for Class I (75±136 vs 121±132 days, p=0.03) and II (83±141 vs 192±185 days, p<0.001), when compared to T-DSA pts. After 1 yr, DSA detection was far less in N-DSA pts (Class I/II 4/8%) than in T-DSA (Class I/II 53/62%, p<0.001) or P-DSA (Class I/II 64/69%, p<0.001) pts. P-DSA pts experienced more clinical TCMR (14 vs 8%, p=0.04), ABMR (12 vs 0.8%, p<0.001), & less normal biopsies (4 vs 11%, p=0.02) than N-DSA pts, and more ABMR than T-DSA pts (12 vs 0%, p=0.003). There were no differences in sub-clinical TCMR/inflammation, tacrolimus levels, renal function, pt survival, or death censored graft survival among all groups. However, lower composite outcome was noted with T & P-DSA pts (Figure 1).

Conclusion

Persistent and Transient DSA within 1 yr had similar outcomes and lower composite outcome when compared to No DSA pts. Thus, detection of DSA within 1 yr, whether Persistent or Transient, is detrimental to renal allograft.