Background: The average annual incidence of de novo donor specific antibody (DSA) has been reported as 3-4% after the first year post-transplant. Recent data suggests an association of de novo DSA with alemtuzumab induction in kidney transplantation. Thus we examined our experience to determine the incidence of de novo DSA post kidney transplantation at our center.

Methods: A single center retrospective analysis of kidney transplants performed with alemtuzumab induction during 2010-2015. DSA was determined by solid phase single antigen bead testing pre-transplant, 1 month, 6 month and yearly post transplant.

Results: 16 patients received a kidney transplant with alemtuzumab induction over the study period. Alemtuzumab induction was associated with early steroid withdrawal in 68% of patients. The median follow up time was 814 days (342-1290 days). Twenty-five percent (4/16) of patients developed de novo DSA after induction with alemtuzumab with an average time to de novo DSA of 387 days (± 135 days). There was no statistically significant difference in donor or recipient characteristics between the two groups, including HLA mismatches and cPRA. In patients with de novo DSA 75% (3/4) had class I only, 25% (1/4) had class II only and no patients had both class I and II. The average sum MFI of de novo DSA was 3600 (312-6943). A kidney biopsy was performed in 75% (3/4) of patients with de novo DSA, of which 100% (3/3) were positive for rejection which was subsequently treated. At last follow up, there was no difference in kidney function between the groups as determined by the average cr/eGFR and the presence of proteinuria.

Conclusion: Alemtuzumab induction was associated with a significant increase in the development de novo DSA. More study is needed to characterize the mechanisms and risk factors associated with de novo DSA development post kidney transplant, and its affect on long term graft kidney allograft survival.

CITATION INFORMATION: Fabbri K, Descourouez J, Jorgenson M, Redfield R. Elevated De Novo Donor Specific Antibody After Alemtuzumab Induction in Renal Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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