Abstract: PO2085
A2 to B Deceased Donor Renal Transplantation Outcome Analysis: A Single-Center Experience
Session Information
- Transplantation: Clinical - Allocation, Evaluation, Prognosis, and Viral Onslaughts
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Bindroo, Sandiya, University of Michigan, Ann Arbor, Michigan, United States
- Doshi, Mona D., University of Michigan, Ann Arbor, Michigan, United States
Background
A2 to B renal transplantation has been underused and significant knowledge gaps are noted in areas of rejections, infection rate, and anti-A titer thresholds post-transplant. The purpose of our study is to assess antibody mediated rejection (AMR) rates in A2 to B DDKT and determine association with anti-A IgG titers. We also assessed graft function, rejection and infection rates.
Methods
Retrospective chart review of 55 A2 to B DDKT performed at the University of Michigan from January 2015 to September 2020 was done. All patients received Thymoglobulin for induction and were maintained on triple immunosuppression. All patients underwent monitoring of anti-A2 titers and surveillance biopsy at 3-, 6- and 12- months after transplant. Other outcomes included graft function, rejection and infection rates at last follow-up.
Results
Our cohort consisted of 55 recipients with mean age of 54(±13) years, 67% males and 29% African Americans. The median follow-up time was 2.5 [0.5-5] years. Ten developed acute rejection at 3 [1-6] months after transplant. One patient developed hyper-acute rejection due to ABO incompatibility, five developed T cell mediated rejection, and four had AMR due to donor specific antibodies (DSA) against HLA. Anti-A titers remained undetectable or less (< 1:4) in 98% patients in post-transplant period with no increase in titers at 3-6 month follow up. Anti-A titer increased to 1:128 in one patient with hyper acute rejection. Overall, 20% mortality was noted, unrelated to graft dysfunction at median follow-up of 1.8 [0.08-4] years. Post-transplant infections (bacterial, viral and fungal) accounted for 41% cases. BK viremia noted in 20% with BK nephropathy in six. The mean (SD) glomerular filtration rate, creatinine and urine protein creatinine ratio at three months, one year and at last follow up post-transplant was 49 (14.69), 1.4(0.47), 0.32 (0.55); 54 (14.49), 1.3 (0.43), 0.17( 0.20) and 52.8 (14.69), 1.4(0.59), 0.22 (0.27) respectively.
Conclusion
Our study showed no overall increase in AMR due to ABOi in A2 to B DDKT and is the first study to assess AMR along with anti-A titers in A2 to B DDKT. More such studies are needed to assess anti-A trajectory with AMR. We also noted high infection and BK viremia rates, attributed to use of Thymoglobulin induction therapy. While A2B transplants have good graft outcomes, infectious complications are more frequent.