Kidney Week

Abstract: SA-PO1152

Clinical Significance of Pretransplant Donor-Specific HLA Antibodies in Kidney Transplant Recipients of Hispanic Population

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

• Avila, Idalia Parra, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, ciudad de mexico , Mexico

Idalia Parra Avila,

• Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, ciudad de mexico , Mexico

Luis E. Morales-Buenrostro,

• Cohen-Bucay, Abraham, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, ciudad de mexico , Mexico

Abraham Cohen-Bucay,

• Ramirez, Silvia, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, ciudad de mexico , Mexico

Silvia Ramirez,

Background

Donor-specific HLA antibodies (DSA) before kidney transplantation (KT) is one of the major risk factors for humoral rejection and lower graft survival. In order to identify prognostic factors and develop follow up strategies in this high risk population, it is required for transplant center to share their outcome data.

Methods

Retrospective cohort and comparative study in KT recipients with pretransplant DSA measured by solid phase assays (Luminex), negative AHG-CDC-XM (living and deceased donor) and negative flow cross match (living donor). Our main objective was to determine graft survival and describe the incidence of acute rejection (AR) and renal function (eGFR by CKD-EPI).

Results

We identified 60 patients with pretransplant DSA and paired them based on donor type, induction therapy and maintenance immunosuppression to 60 KT recipients that did not have pretransplant DSA. The incidence of AR was higher in the pretransplant DSA group (35.5% vs. 15.2%, p=0.011) and the median time between KT and AR episodes was shorter in the pretransplant DSA group [12.8 (8.3-23.6) vs 32.1 (25.9-40.6) months, (p<0.0001)]. After 37.4 (range 29.2-52.3) months of follow up, eGFR was similar between groups [65.0 ± 22.0 vs 69.8 ± 21.4 ml/min/1.73m² (p=0.19)] and there was no difference in graft survival (87.7% vs 96.7% p=0.240) between groups with and without pretransplant DSA, respectively.

Conclusion

Although there is a higher incidence of rejection, KT recipients with pretransplant DSA had similar eGFR and graft survival. Therefore, this group of higher immunological risk could still be considered candidates for KT. One limitation of this study is the small sample size and short follow-up time. However, we propose that induction therapy with lymphocyte depleting agents and powerful maintenance immunosuppression, combined with follow-up strategies as protocol biopsies with early treatment of subclinical rejection could provide similar graft survival in KT recipients with and without pretransplant DSA.