Kidney Transplant with Low Level DSA and Low Positive B-Flow Crossmatch: An Underappreciated Option for Highly Sensitized Transplant Candidates.
Transplant Center, Mayo Clinic, Rochester, MN.
Meeting: 2016 American Transplant Congress
Abstract number: D8
Keywords: Alloantibodies, Graft survival, Panel reactive antibodies, Rejection
Session Information
Session Name: Poster Session D: Antibody Mediated Rejection: Session #2
Session Type: Poster Session
Date: Tuesday, June 14, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: Avoiding DSA is difficult in sensitized patients. A kidney transplant (KTx) with low level DSA with or without a low level B flow cytometric crossmatch (BFXM) may be reasonable, but data to support this is lacking. We examined transplant outcomes when low level DSA was present.
Methods: All solitary KTx from 10/2007 and 5/2014 (N=954) were divided into groups: -DSA/-BFXM (N=794), +DSA/-BFXM (N=57), +DSA/low +BFXM (mean channel shift 106-199) (N=35), +DSA/high +BFXM (mean channel shift >199)(N=43), and –DSA/+BFXM (N=24). 87.4% of +DSA/high+ BFXM patients were desensitized, but this was uncommon in other groups. Protocol biopsies were done 1, 2 and 5 years post-transplant.
Results: Death-censored allograft survival was lowest in the +DSA/high BFXM group (79.1%, p<0.01), but was similar among the other groups over mean follow-up of 4.1 ± 1.9 years. Early clinical antibody mediated rejection (AMR) was highest in +DSA/high +BFXM (16.3%) group and the following in other groups: -DSA/-BFXM =0.9%, +DSA/-BFXM=0.0%, +DSA/low +BFXM=5.7%, and –DSA/+BFXM =4.0%, p<0.01. The cumulative incidence of chronic AMR (Banff cg score >0) was also different among groups: -DSA/-BFXM=8.1%, +DSA/-BFXM=15.8%, + DSA/low+ BFXM=31.4%, +DSA/high+ BFXM=51%, and –DSA/+BFXM=16.7%. Importantly, even when no DSA was present at transplant (-DSA/-BFXM group), chronic AMR was increased in patients with a cPRA >80% [HR 3.4 CI(1.7-6.1) p=0.02]
|
Group |
Allograft survival (mean f/u 4.1 yrs) |
Early clinical AMR |
Chronic AMR |
|
-DSA/-BFXM |
96.6% |
0.9% |
8.1% |
|
+DSA/-BFXM |
87.1% |
0.0% |
15.8% |
|
+DSA/low+BFXM |
97.1% |
5.7% |
31.4% |
|
+DSA/high+BFXM |
79.1% |
16.3% |
51.0% |
|
-DSA/+BFXM |
95.8% |
4.0% |
16.7% |
|
p-value |
P<0.01 |
P=0.02 |
P<0.01 |
.
Conclusions: KTx recipients with low DSA with or without low + BFXM have comparable death-censored allograft survival to patients who were DSA negative pre-transplant at mean follow-up of 4.1 years. The incidence of chronic AMR was higher with pre-transplant DSA, but patients with a high cPRA were at risk for chronic AMR even without DSA. This suggests that KTx in patients with low DSA or low positive BFXM may be an acceptable option for select highly sensitized transplant candidates (cPRA>80%), and may be preferred to prolonged waiting for a DSA negative transplant.
CITATION INFORMATION: Schinstock C, Cheungpasitporn W, Cosio F, Mitema D, Gandhi M, Prieto M, Dean P, Stegall M. Kidney Transplant with Low Level DSA and Low Positive B-Flow Crossmatch: An Underappreciated Option for Highly Sensitized Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Schinstock C, Cheungpasitporn W, Cosio F, Mitema D, Gandhi M, Prieto M, Dean P, Stegall M. Kidney Transplant with Low Level DSA and Low Positive B-Flow Crossmatch: An Underappreciated Option for Highly Sensitized Transplant Candidates. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplant-with-low-level-dsa-and-low-positive-b-flow-crossmatch-an-underappreciated-option-for-highly-sensitized-transplant-candidates/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress