Background: Development of Denovo donor specific antibodies (DnDSA) has been associated with poor allograft outcomes in few studies. However, there is scarcity of data evaluating outcomes in patient on steroid free Immunosupression who develop DnDSA after one year of kidney transplant.

Method: A retrospective chart review was done on all patients with prospective and for cause donor specific antibody (DSA) testing between 2009 and 2011 at Indiana University Transplant program. All patients with positive flow cytometry crossmatch, presence of pre transplant DSA, Recurrent or Denovo DSA in the first year were excluded from the study. Patients received anti- thymocyte globulins with pulse steroid induction (Early five days withdraw) except zero mismatches living donor recipients who received basiliximab. Patients were placed on steroid free two drug Immunosuppression regimen. Donor specific antibodies were checked using single antigen beads (One Lambda Inc.). Clinical outcomes analysis was done comparing patient with DnDSA (>1yr.DNDSA) development after their first year of transplant versus those with no history of DSA (No DSA).

Results: 144 patients were included in the final analysis over a study period of 8.5 years. Mean follow up time was 6.03 years.13.2% of the study cohort had Denovo DSA after 1 year of Kidney transplant. Acute rejection after the first year of kidney transplant were 31.6% vs 0.8% (p<0.0005) in >1YrDnDSA[SAA1] vs No DSA groups respectively. Death censored graft survival over study period was worse in the >1yrDnDSA group vs No DSA group (63.2% vs 95.2% respectively, p<0.0005). There were no significant differences in patient survival (p=0.017) and eGFR at 5 years post-transplant (P=0.1)

Conclusion: Patients on steroid free Immunosupression regimen who developed Denovo DSA after the first year of kidney transplant appears to be at increased risk for acute rejection and graft loss. A long term prospective monitoring for DnDSA may help identify patients at risk for poor outcomes.

CITATION INFORMATION: Sharfuddin A., Yaqub M., Mishler D., Goggins W., Taber T., Adebiyi O. Development of Denovo DSA after One Year Post Kidney Transplant and Clinical Outcomes in Patient on Steroid Free Immunosupression Am J Transplant. 2017;17 (suppl 3).

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