*Purpose: We hypothesized that sensitized patients with preformed DSAs other than anti-HLA A, B, DR could receive less intensive induction therapy.

*Methods: Single center retrospective cohort study, including consecutive recipients of ABO-compatible deceased donor kidney transplants (KT). Allocation based on pretransplant virtual crossmatch (XM) using the last tested serum sample (lack of any anti-A, -B, and -DR DSA with mean fluorescence intensity [MFI] > 1500), followed by a negative complement-dependent cytotoxicity XM, using the most recent serum sample. Within 24 hours after transplantation, among sensitized recipients and retransplants, any DSA (A, B, C, DR, DQ, DP) in any stored serum sample, including the most recent one, prompted flow-cytometry crossmatch (FC-XM). Immunosuppression consisted of 3mg/kg single dose of antithymocyte globulin plus tacrolimus, prednisone and mycophenolate. Additional induction therapy with plasmapheresis (PF) and high dose intravenous immunoglobulin (IvIg) was considered in patients with positive FC-XM. Only for cause biopsies were performed.

*Results: Of 2,355 KT performed between 12/10/2015 and 07/12/2018, 58 (2.4%) were included in the analysis. Of them, 22 had both T and B-cell negative FC-XM (T-/B-), 10 had both T and B-cell positive FC-XM (T+/B+), and 25 had only B-cell positive FC-XM (T-/B+). Additional induction therapy with 5 PF sessions plus 2g/kg (IvIg) was performed in 5 (50%) T+/B+ patients and in 12 (48%) T-/B+ patients. Within 3 months after transplantation, there were only 3 episodes of antibody mediated acute rejection: 2 in patients with T+/B+ FC-XM who had preformed A, B or DR DSA in the most recent serum, and one in a retransplant patient with T-/B+ FC-XM who had preformed DQ DSA (Table).

*Conclusions: These preliminary data suggest that less intensive induction resulted can be used in KT recipients with DSA other than anti-HLA A,B, and DR, without an increased risk of early acute allograft rejection.

« Back to 2019 American Transplant Congress