The relationship between mycophenolate (MPA) dose and the development of donor specific antibody (DSA) following pancreas transplant has not been elucidated. This study evaluates the impact of high dose (3 g MMF daily, HD-MPA) as compared to standard dose (2 g MMF daily, SD-MPA) on the incidence of DSA development within in the first post-transplant year.

Adult simultaneous pancreas-kidney (SPK) recipients transplanted between 2/23/2013-6/30/2015 were divided based on MPA dose at time of discharge. DSA test results were analyzed throughout the first year post-transplantation. A patient was reported to have developed DSA when either human leukocyte antigen (HLA) Class I or HLA Class II mismatches resulted in positive values.

The groups were well matched with similar baseline characteristics; 31 patients were discharged on HD-MPA; 35 on SD-MPA (47 vs 53%). The average number of HLA mismatches at time of transplant was similar between groups (HD-MPA 4.5±1.2 vs SD-MPA 4.3±1.2, p=0.57). In the first year post-transplant 22% (n=13) developed de-novo DSA overall. There was no difference in overall development of DSA at 1 year between groups (HD-MPA 26% vs SD MPA 20%, p=0.69). However, there was a significant difference in the type of DSA with 25% of HD-MPA DSA mismatches Class I, 62.5% Class II and 12.5% both Class I and II vs SD-MPA dose group with 14% Class I, 43% Class II and 43% both Class I and II (p<0.001). Pancreas graft survival was higher among patients on HD-MPA at 4 years (100 vs 74%, p=0.003); as was kidney (100 vs 89%, p=0.05). There was no difference in pancreas (p=0.31) or kidney allograft rejection (p=0.30) or patient survival at 4 years (p=0.18). However, patients had significantly more infectious complications in the HD group (p=0.049).

Although HD-MPA did not impact development of DSA, it had a significant survival benefit for both pancreas and kidney allografts which appears to be independent of overall DSA development. However, this benefit may be at the cost of increased infectious complications. Future studies are needed to further evaluate the long term graft survival benefits of HD-MPA, in light of possible associated infectious risk.

CITATION INFORMATION: Descourouez J., Jorgenson M., Twigg A., Leverson G., Odorico J., Redfield R. Evaluation of MPA Dose on Development of DSA Following Pancreas Transplant Am J Transplant. 2017;17 (suppl 3).

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