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Kidney Week

Abstract: PO2571

Patient and Graft Outcomes of Kidney Transplant Recipients with Anti-Human Neutrophil Antigen Antibodies

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Mejia, Christina Irene, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Katz-Greenberg, Goni, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Colombe, Beth W., Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Singh, Pooja, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Yadav, Anju, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Background

Antibody mediated rejection (AMR) is a well-established cause of poor graft outcomes in kidney transplant recipients (KTR). While the most common targets are human leukocyte antigen (HLA) antibodies (abs), there are data implicating some non-HLA abs in the process of AMR. Human neutrophil antigens (HNA) are glycoproteins expressed on neutrophil surfaces. Anti-HNA abs have been associated with transfusion-related acute lung injury but their role in AMR in KTR is unclear. The aim of our study was to examine the outcomes of KTR with anti-HNA abs at our center.

Methods

We retrospectively reviewed the medical records of KTR with non-HLA abs between 1/2008-5/2020. Relevant clinical and graft outcome data were obtained. Descriptive statistics were expressed as absolute numbers (%) for categorical data and as medians with interquartile range (IQR) for skewed distribution.

Results

There were 6 KTR with non-HLA abs during the study period, all anti-HNA abs. Three patients (pts) were male (50%), 5 white (83%), and 4 had polycystic kidney disease (PCKD) as primary disease (66%). Median age at KT was 46 (29.75-57). Pts' characteristics, clinical course and outcomes are detailed in Table 1. Five pts developed biopsy-proven AMR at a median of 32 months (13.8-68.2) from KT. During follow-up (f/u), 3 pts had graft loss, 1 of which was re-transplanted while 2 are re-listed but dialysis-dependent. Mean creatinine of the 4 pts with working allografts is 1.21mg/dL(1.14-1.27) at median f/u of 68 months(52-105).

Conclusion

We observed varied clinical courses and graft outcomes in our pts, partly due to our small cohort. Although majority developed AMR, it was not necessarily associated to graft loss or shortened graft survival. Of note, PCKD was the primary kidney disease in the majority of pts, similarly observed in one other case series. More studies are needed to determine the specific significance of anti-HNA abs in KTR.

Table 1. Patient and donor characteristics and allograft outcomes.
PatientGenderRaceAge at transplantCause of kidney diseaseDialysis ModalityTransplant numberDonor typeInductionBaseline Immunosuppression (IS)Delayed Graft FunctionAnti-HNA ab GenotypeHLA DSA (at time of biopsy)Biopsy-proven AMRTreatmentGraft lossCurrent status
1MaleWhite20IgA NephropathyHemodialysis1Living-unrelatedAnti-thymocyte globulin (ATG)Tacrolimus, MycophenolateNo3a,3b,5aYesYesIntravenous Immunoglobulin (IVIG), Plasmapheresis, RituximabYesRe-transplant, Creatinine (Cr) 1.23 mg/dl
2FemaleWhite33Polycystic kidney diseaseHemodialysis2Donation after brain deathATGTacrolimus, Mycophenolate, PrednisoneUnknown2, 3a, 3b,5bNoYesATG, IVIG, Plasmapheresis, RituximabYesDialysis-dependent
3FemaleNon-hispanic black45HypertensionHemodialysis4Donation after brain deathATGTacrolimus, Mycophenolate, PrednisoneYes1b, 2, 3a, 3bNoYesNoneNoCr 1.17 mg/dl
4MaleWhite47Polycystic kidney diseasePeritoneal dialysis1Living-unrelatedATGTacrolimus, MycophenolateNo2, 3bNoYesPrednisone added to IS regimenNoCr 1.27 mg/dl
5MaleWhite57Polycystic kidney diseasePreemptive1Living-unrelatedATGTacrolimus, Mycophenolate, PrednisoneNo2,3b,5a (preformed)YesNoIVIG, Plasmapheresis (peri-transplant)NoCr 1.20 mg/dl
6FemaleWhite57Polycystic kidney diseasePreemptive1Living-relatedBasiliximabTacrolimus, Mycophenolate, PrednisoneNo3a (preformed)NoYesATG, IVIG, PlasmapheresisYesDialysis-dependent