Background: Positive flow cytometry crossmatch (FCXM) is considered a high immunologic risk for transplantation. Available studies reporting outcomes in positive FCXM kidney transplants were done either in the setting of living donor transplant or steroid based immunosuppression protocol.

Methods: A retrospective chart review of all deceased donor kidney transplant recipients in our center from 1/06 to 6/14 with positive flow cytometry crossmatch at time of transplantation was undertaken to evaluate graft outcomes. Patients were induced with r-ATG and a steroid-free protocol . Patients without donor specific antibodies (DSA) at time of transplant or with less than one year of follow-up were excluded. Acute rejection (AR) and graft survival were compared to the national Scientific Registry of Transplant Recipients data on deceased donor transplants (DD-SRTR).

Results: 21 patients (study group) with positive FCXM kidney transplant met our inclusion criteria with Mean Class I/II PRA of 45.6% and 49.1% respectively. Mean follow-up time was 4.73 years. 20/21 patients received peri-transplant treatment (See Table 1) One year AR rate in the study group was 33.3% compared to 10.58 % in the DD-SRTR data. Graft survival at 1, 3 and 5 yrs was 100%, 95.2% and 75% respectively in the study group vs. 91.2%, 82.7% and 72%, respectively, in the DD-SRTR data. Mean 1 yr MDRD GFR and proteinuria were 65.8+/- 19.7 ml/min and 0.43g/dl, respectively. Three-year patient survival was 100%. Pre transplants DSA were either undetectable or levels trended downward at one-year post-transplant in most patients (17/21).

Conclusion: Our study results suggests a steroid-free protocol can be performed safely in deceased donor renal transplant recipients with positive pre-transplant FCXM with no increased risk for poorer intermediate term graft survival, despite a higher rate of one-year AR.

CITATION INFORMATION: Adebiyi O, Taber T, Goggins W, Mishler D, Yaqub M, Sharfuddin A. Steroid Free Immunosuppression and Clinical Outcomes in Recipients of Deceased Donor Kidney Transplant with Positive Flow Cytometry Crossmatch. Am J Transplant. 2016;16 (suppl 3).

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