A2 Kidneys into B Recipients: Is Postoperative Anti-A1 Titer Monitoring Useful?
Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN.
Meeting: 2016 American Transplant Congress
Abstract number: A111
Keywords: Antibodies, Kidney transplantation, Plasmapheresis, Rejection
Session Information
Session Name: Poster Session A: Kidney Desensitization
Session Type: Poster Session
Date: Saturday, June 11, 2016
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Background: Since the introduction of the new Kidney Allocation System in December 2014, our center implemented a protocol for transplanting A2 kidneys into B recipients which includes postoperative anti-A1 titer monitoring. Previous studies have shown successful kidney transplantation from A2 donors into B recipients when recipient IgG titers are < 1:8. However, no studies have prospectively evaluated the relevance of anti- A1 titers following A2 to B kidney transplantation.
Methods: We prospectively monitored post-transplant IgG and IgM/IgG titers at 4 and 12 weeks in all B recipients of A2 kidneys. All recipients had pre-transplant anti-A IgG titers < 1:8 and IgM/IgG titers ≤ 1:64. All recipients received alemtuzumab, methylprednisolone, and maintenance tac/MMF/pred. If IgG < 1:8 but IgM/IgG was ≥ 1:8 but ≤1:64, plasmapheresis, IVIG, and rituximab were also given.
Results: Since December 2014 we performed 10 A2 to B deceased donor kidney transplants. All patients had pre-transplant IgG titers <1:8. Four patients had low IgM/IgG titers and received alemtuzumab/tac/MMF/pred. Six patients had high IgM/IgG titers and also received PP/IVIG/Ritux. IgG titers increased in 6 patients from pre-transplant to 4 weeks post-transplant. Of the 7 patients who had titers at 12 weeks, no patients had further increases in titer, 4 patient's titers remained the same and 3 decreased. Two patients underwent biopsy for acute renal dysfunction which showed ATI/CNI toxicity in patient #1 and ATI in patient #6.
| Pt | Anti-A1 Titers |
Path
|
|||||
|---|---|---|---|---|---|---|---|
| Pre-Tx | 4 wks | 12 wks | |||||
| IgG | IgM/G | IgG | IgM/G | IgG | IgM/G | ||
| 1 | 1:4 | 1:64 | 1:8 | 1:16 | 1:2 | 1:16 | ATI/CNI Tox |
| 2 | 1:4 | 1:4 | 1:1 | 1:8 | 1:1 | 1:8 | None |
| 3 | 1:1 | 1:8 | 1:128 | 1:256 | 1:32 | 1:64 | None |
| 4 | 1:4 | 1:32 | 1:2 | 1:16 | 1:2 | 1:8 | None |
| 5 | 1:2 | 1:8 | 1:32 | 1:64 | 1:8 | 1:16 | None |
| 6 | 1:2 | 1:32 | 1:16 | 1:128 | 1:16 | 1:64 | ATI |
| 7 | 1:4 | 1:16 | 1:2 | 1:8 | – | – | None |
| 8 | 1:2 | 1:32 | 1:8 | 1:32 | 1:8 | 1:16 | None |
| 9 | 1:4 | 1:16 | 1:4 | 1:8 | – | – | None |
| 10 | 1:2 | 1:8 | 1:8 | 1:32 | Pending | Pending | None |
No patients had acute rejection to date regardless of post-transplant anti-A1 titers and all have functional grafts.
Conclusions: Our preliminary data show considerable variation in anti-A1 titers post-transplant with no correlation between a rise or change in titer and acute rejection or renal function. Routine postoperative anti-A1 titer monitoring may be of little or no clinical utility in A2 to B kidney transplants.
CITATION INFORMATION: DeMers A, Forbes R, Moore D, Smith K, Shaffer D. A2 Kidneys into B Recipients: Is Postoperative Anti-A1 Titer Monitoring Useful? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
DeMers A, Forbes R, Moore D, Smith K, Shaffer D. A2 Kidneys into B Recipients: Is Postoperative Anti-A1 Titer Monitoring Useful? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/a2-kidneys-into-b-recipients-is-postoperative-anti-a1-titer-monitoring-useful/. Accessed November 25, 2024.« Back to 2016 American Transplant Congress