Introduction:

Pre-Transplant Microbead donor HLA specific antibody(DSA) positive but cell crossmatch negative transplants are considered to be at increased immunological risk. This study aimed to address whether the consequences of enhanced Immunosuppression outweigh the risk of acute Antibody Mediated Rejection, and whether subsequent Immunosuppression reduction causes re-emergence of DSA.

Methodology: Retrospective data was collected on 29 out of 500 Living Donor Kidney Transplant recipients at a single centre (Jan '09-Jan 2015). These patients were cell based crossmatch (CDC) negative but DSA positive at the time of transplantation. Data was collected on post transplant DSA activity, Immunosuppression, rejection, events including systemic infections, viraemia and marrow suppression.

Results: The median follow up was 2.5 years (1yr-5yrs.) Standard induction agents were used (Basiliximab:23, Campath:4 and ATG:2) followed by either Dual Therapy (DT: n=9):Myfortic & Tacrolimus) or Triple Therapy (TT; n=20;Myfortic, Tacrolimus and Prednisolone). Rejection within first seven days were 3 vascular and 0 ABMR.

At 6 months post-transplant, 11 were on DT and 18 on TT. During this time, infection developed in 3 patients on DT (27%) and 6 on TT (33%). 1 patient on DT (9%) and 4 on TT (22%) developed myelosuppression i.e leucopenia.

At 12 months, 16 patients were on DT and 11 were on TT. In this group, 4 patients on DT had infections (25%) compared to 3 on TT (27%).

The DSA titres at 6 months were unchanged in 12 (92%) on DT and 12 (75%) on TT. Also at 12 months the DSA titres remained unchanged in 16 (81%) on DT and 10 (83%) on TT.

Conclusions

This study demonstrated that patients on Triple Therapy have a higher incidence of infections and myelosuppression as compared to those on Dual Therapy. DSA status was unchanged in both groups at 6 months and 1 year, this suggests that the use of TT in patients who have low levels of DSA at the time of transplantation may not provide any additional benefit but maybe associated with a higher rate of infections in these patients. A larger study is needed to clarify the use of augmented Immunosuppression in low titre DSA positive transplant recipients.

CITATION INFORMATION: Bhutani S, Ponnusamy A, Tak Q, Shah S, Worthington J, Summers A, Poulton K, Van Dellen D, Morton M, Picton M. Do We Need an Individually Tailored Immunosuppression Strategy for Living Donor Kidney Transplant Recipients with PreTransplant Donor Specific Antibodies? A Retrospective Analysis. Am J Transplant. 2016;16 (suppl 3).

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