Retransplant (RTx) patients are often sensitized due to donor-specific antibody (DSA) formation, with higher acute rejection rates during subsequent transplants vs patients without DSA. However, little data exist on antibody specificity distribution, and hazard of transplants regarding de novo DSA (dnDSA) formation. We evaluated how prior transplant contributes to dnDSA in one of the largest, single-center, retrospective cohorts to date, and with modern immunosuppression.

Single-center demographic and laboratory data were collected for all adult kidney transplant (KT) patients from 2007–2015. For primary vs RTx patients, DSA was assessed per protocol at transplant (time 0), 3 and 6 months, 1 and 2 years, and for cause. Continuous variables were summarized by mean/standard deviation (SD), and categorical variables by number/proportion.

Overall, 1386 adult KT patients (primary transplant: n=1224; RTx: n=162) were followed for ≤8 years, >4,500 patient-years (py) of follow-up. Recipient and donor characteristics were generally similar between primary and RTx groups; however, RTx patients were younger at time of most recent transplant, a greater proportion were Caucasian, and mean maximum panel reactive antibody score was higher. Incidence rate of dnDSA in RTx vs primary KT was: Class I, 5.5/100 vs 4.5/100 py; Class II, 6.1/100 vs 3/100 py. RTx vs primary KT patients were more likely to develop dnDSA (hazard ratio (HR) 1.42), with Class I specificities presenting greater hazard than Class II for dnDSA formation. RTx patients were more likely to develop dnDSA in human leukocyte antigen A, B, C and DR loci (HRs 2.3–2.7) (Figure 1).RTx vs primary KT were more likely to develop dnDSA. However, hazard for Class I dnDSA development was equal to or greater than for Class II. As graft loss is mostly associated with Class II formation, impact of these data is unknown, requiring further study.

CITATION INFORMATION: Atiemo K, Ho B, Bhagat H, Lee E, Daud A, Kang R, Montag S, Zhao L, Schwartz J, Ladner D. De Novo Donor-Specific Antibody Formation After Kidney Retransplant Is Associated with Specificity Against Class I. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress