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Kidney Week

Abstract: SA-PO1059

Impact of Donor-Specific Antibodies (DSA) with Low Median Fluorescent Intensity (MFI) on Allograft Outcomes in Kidney Transplant

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Kitpermkiat, Rungthiwa, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  • Wiwattanathum, Punlop, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  • Kantachuvesiri, Surasak, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
Background

Many factors are associated with allograft failure in kidney transplantation patients (KTs). Immune-mediated rejection is one of the most common causes of allograft failure. Many studies demonstrated that high level of donor specific antibody (DSA) correlated with complement binding capability and more severe tissue injury. However, data on DSA with low MFI are scarce. We compared allograft outcomes in KT patients with low-MFI DSA in this study.

Methods

Post kidney transplant patients who were tested for DSA at Ramathibodi Hospital from January 2007 to December 2021 and had DSA with MFI < 1000, reported as negative, were evaluated. KTs were separated into two groups: those with very low DSA (VLL) (MFI 1-500) and those with low DSA (LL) (MFI <a href="tel:501-1000">501-1000</a>). The primary outcome was the incidence of acute rejection. One and 5-year serum creatinine, allograft and patient survival in KTs with and without antibody-mediated rejection (ABMR) were also studied. Univariate and multivariate analyses were used to analyze factors associated with rejection.

Results

Thirty-six KTs were identified (VLL n = 27, LL n = 11). Demographic characteristics were similar between the 2 groups except slightly higher use of ATG for induction in LL group. The LL group had significantly higher T-cell mediated rejection (TCMR) than the VLL group (45% vs. 12%, P = 0.04). Ten patients developed ABMR. Rate of ABMR, 5 years allograft survival and patient survival were comparable between groups. There was a trend toward higher MFI in KTs with ABMR than without ABMR (MFI 442 [74-684] vs. 198 [33-475]; P = 0.21). At 5 years, the median serum creatinine level among ABMR was significantly higher than in non-ABMR KTs (2.25 [2.00-2.98] mg/dl vs. 1.41 [1.11-1.87] mg/dl) (P = 0.03). Univariate and multivariate analyses revealed that LL was a risk factor for rejection.

Conclusion

DSA with low MFI is associated with higher incidence of rejection. DSA with low MFI should not be reported as negative and overlooked. All DSA should be reported regardless of MFI. These group of KTs should be monitored closely and have their immunosuppression intensified to reduce the incidence of rejection.

Funding

  • Government Support – Non-U.S.