Introduction

The presence of de novo DSA (dnDSA) is associated with antibody mediated rejection and less optimal graft outcomes. The overall incidence of dnDSA post renal transplant varies according to immunosuppression protocols, screening, and detection methods, and ranges from 5-25%. Specifically, a higher incidence of dnDSA following alemtuzumab (AL) has been observed. We sought to characterize the expression of early dnDSA development after AL induction in renal transplant recipients.

Methods

Consecutive kidney transplant recipients were screened for the presence of dnDSA from 7/1/2014 to 6/30/2015. Induction protocol consisted of alemtuzumab with rapid steroid withdrawal, and maintenance immunosuppression was with tacrolimus and mycophenolate mofetil.DnDSA was detected by single antigen beads and luminex technology at months 1, 2, 3, 6 and 12. Mean Fluorescent Intensity (mfi) > 500 was considered positive.

Results

A total of 60 renal transplants were performed from 7/1/14 to 6/30/15 and were followed for average of 10.3 months (range 4-16). Of these, 22 developed dnDSA (36.6 %) in the first 6 months; 15 class I, 10 class II and 3 both. Class I was detected at months 1 (8), 2 (3), 3(1) and 6 (3). Class II was detected at months 1 (3), 2 (3), 3(2) and 6 (2). Median mfi at the time of onset was 3985 (range 544- 7427) for class I and 12,539 (range 502- 24,576) for class II. Of this cohort, 22/60 patients completed one year of screening; 9/23 had developed dnDSA as described above. Of these, the DSA cleared without any intervention in five patients (55%). The levels remained unchanged with stable graft function in 3 (33%) of the patients.One patient had persistent DSA > 5000 mfi, was treated with plasmapharesis , IVIG and Rituximab . The DSA still remains high but the graft function was unchanged so patient is being monitored closely.

Conclusions

In this cohort, dnDSA developed in 36.6% of recipients, with the majority developing in the first 2 months (77 %). In 50% of the patients that were followed for one year, the DSA cleared with no intervention with stable graft function.Despite their DSA positive status, patients with early de novo DSA did not fare worse than those without at one year.

CITATION INFORMATION: Nigatu Y, Estrada C, Darras F, Suh H, Abate M, Nord E. Monitoring of De Novo DSA Post Alemtuzumab Induction in Renal Transplant Recipients: One Year Follow Up. Am J Transplant. 2016;16 (suppl 3).

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