Protocolar Biopsies in Patients with Subclinical De Novo DSA in Kidney Transplantation
1Nephrology Kidney Transplantation Dialysis, CHU Rouen, Rouen, France
2Nephrology Kidney Transplantation, CHU Amiens, Amiens, France
3Nephrology Kidney Transplantation, CHU Clermont Ferrand, Clermont Ferrand, France
4Nephrology Kidney Transplantation, CHU Angers, Angers, France
5Nephrology Kidney Transplantation, CHU Caen, Caen, France
6Nephrology Kidney Transplantation, CHU Strasbourg, Strasbourg, France
7Nephrology Kidney Transplantation, CHU Brest, Brest, France
8Nephrology Kidney Transplantation, CHU Poitiers, Poitiers, France
9Pathology, CHU Rouen, Rouen, France
10EFS Normandie, EFS Normandie, Rouen, France
11Nephrology Kidney Transplantation, CHU Tours, Tours, France.
Meeting: 2018 American Transplant Congress
Abstract number: A92
Keywords: Antibodies, Biopsy, Rejection
Session Information
Session Name: Poster Session A: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
De novo donor-specific antibody (DSA) is associated with antibody-mediated rejection (ABMR) and allograft loss. The aim of our study was to examine the histology associated with subclinical de novo DSA and to identify predictive factors of subclinical ABMR.
Retrospective multicentric study (9 french kidney transplant units of the Spiesser Group). All patients with a de novo DSA (One Lambda, MFI > 1000) without graft dysfunction and biopsied for DSA apparition were included in the study. Clinical, biological and histological characteristics of the patients were studied.
107 patients (76M/31F; mean age: 49.3 +/- 12.7 years old) were biopsied 3.7 months (median) after the occurrence of a de novo DSA and after 65.3 months (median) after kidney transplantation. Graft function was stable during the 3 months before biopsy: MDRD = 57.3 +/- 18.7 mL/min/1.73 m[sup2]; proteinuria = 0.16 +/- 0.14 g/g. DSA was in a large part a class 2 DSA (class 2 alone: 70.3%). Biopsy led to the diagnosis of ABMR according to Banff score in 42 cases (39.2%) with peritubular C4d deposition in 15 cases (35.7%). Univariate analysis showed that the absence of steroids on the day of biopsy, presence of both class 1 and 2 DSA, the MFI of immunodominant DSA and the sum of the MFI of the DSA were associated with the diagnosis of subclinical ABMR. In multivariate analysis, only the sum of the MFI were still predictive (MFI > 7832: OR=5.92, 1.63-21.46, p=0.006).
Performing a kidney graft biopsy for the occurrence of de novo DSA without renal dysfunction lead to the diagnosis of a subclinical ABMR process in about 40%. This screening, guided by antibodies intensity, might allow the clinicians to initiate a specific tratement early before the organ dysfunction.
CITATION INFORMATION: Bertrand D., Jaureguy M., Garrouste C., Sayegh J., Bouvier N., Caillard S., Lanfranco L., Galinier A., François A., Hau F., Etienne I., Gatault P. Protocolar Biopsies in Patients with Subclinical De Novo DSA in Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Bertrand D, Jaureguy M, Garrouste C, Sayegh J, Bouvier N, Caillard S, Lanfranco L, Galinier A, François A, Hau F, Etienne I, Gatault P. Protocolar Biopsies in Patients with Subclinical De Novo DSA in Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/protocolar-biopsies-in-patients-with-subclinical-de-novo-dsa-in-kidney-transplantation/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress