Background: Thymoglobulin (ATG) and basiliximab (Bas) induction are commonly used therapies to prevent allograft rejection in kidney transplant recipients (KTx). Formation of donor specific antibodies (DSA) has been shown to be a reliable predictor of antibody mediated rejection (AMR). The aim of this study was to evaluate the rate of DSA formation in patients who were induced with ATG or Bas.

Methods: We analyzed 28 cases of kidney transplant performed between August 2013 and August 2015 at our institution. All pts had at least a greater than 3 mismatch and cPRA <20. Luminex testing was used to detect DSA. DSA were tested at monthly intervals x 3 then q 3 month x 2 and if clinically indicated. We compared the rate of DSA formation between patients who received ATG (n = 18) versus Bas (n = 10). Dosing: two 20 mg doses of Bas and 3-6 mg/kg ATG were used. Triple I/S was used for maintenance [Tacrolimus (target levels 6-8), Prednisone and MMF]. For each DSA specimen, we collected information on the total number of DSAs formed (class I versus class II), the DSA mean fluorescence intensity strength if the value > 1000, and the total number of non-DSAs formed (class I versus class II). We evaluated these parameters at two time points: < 180 or > 180 days from transplant. Results: For DSAs performed < 180 days, the mean number of days elapsed since transplant was 58 and 29 in patients receiving ATG and Bas respectively (standard deviation 44.25 and 16.64). In the ATG group, 2/17 (11%) had a positive DSA, whereas 3/7 (42 %) of Bas had a DSA. For DSAs performed > 180 days, the mean number of days elapsed since transplant was 451 and 305 in patients receiving ATG and Bas, respectively (standard deviation 194.72 and 91.28). In the ATG group, 0 out of 5 had a positive DSA. In the Bas group, 3 out of 5 (60 %) had a positive DSA. Patients receiving Bas produced more class II DSAs compared to patients receiving ATG (p < 0.05). By contrast, patients receiving ATG produced more class I non-DSAs compared to patients receiving Bas (p < 0.05). Conclusion: In this single center prospective study comparing the rate of de novo DSA formation, Bas was associated with a higher rate of de novo DSA formation. Data is being collected prospectively to understand the long term clinical implications of this observation.

CITATION INFORMATION: Gong A, Lee K, Patel S, Brande M, Dhawan R, Parke C, Smogorzewski M, Aguirre L, Duong B, Alexopolus S, Qazi Y. Comparison of De Novo Donor Specific Antibody Formation for Kidney Transplant Recipients Induced with Thymoglobulin or Basiliximab. Am J Transplant. 2016;16 (suppl 3).

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