*Purpose: In renal transplantation, the clinical effects of donor specific antibodies (DSA) against HLA-DP are unclear. We report successful kidney transplants in three highly sensitised individuals with significant HLA sensitisation including donor directed HLA-DP antibody without prior antibody removal. All of our cases had a positive B cell flow cytometric crossmatch (FCXM) and HLA-DP DSA mean fluorescence intensity MFI >20,000 (Luminex SAB).

*Methods: Case Report Case 1 A 68 year old male patient known to be highly sensitized ,with a cRF of 100% from previous two renal transplants with relative mean fluorescence (RMF) of 2.52 and 4.13 for T and B cell respectively (cut off is 1.48 for T cell and 1.88 for B cell), received the third kidney from a donation after brain death (DBD) donor. HLA mismatch was 1.1.1. There was delayed graft function (DGF) with no evidence of rejection on the biopsy. He had a slow improvement of graft function. After two years, he had a marginal increase in serum creatinine (199µmol/L) with estimated glomerular filtration rate (eGFR) 29 mL/min/1.73 m². Transplant kidney biopsy confirmed transplant glomerulopathy. Kidney function was stabilized on Angiotensin Converting Enzyme Inhibitors and the latest creatinine was 238. Case 2 A 58 year old male patient received a DBD kidney allograft. HLA mismatch was 1.1.0 and RMF of 1.81 and 2.34 for T and B cell respectively. His cRF was 100%. He developed DGF necessitating dialysis. A biopsy on 7^th day showed no rejection. Following slow improvement, the patient was discharged on day 14 with good urine output and serum creatinine of 430. His latest serum creatinine was 229 µmol/L (eGFR 26). Case 3 A 53 year old male patient received a second kidney transplant in 2019 from a DBD donor with HLA mismatch of 1.1.1 and RMF 3.3for B cell and had an immediate graft function. On day 10, he had an acute deterioration of creatinine to 295 (eGFR of 20) for which a biopsy was done and showed features of AMR with a brisk rise in DSA’s. Following treatment with plasma exchange, graft function returned to baseline level.

*Results: Stable graft function for all the cases.

*Conclusions: Transplantation of highly sensitized patients with positive FCXM due to HLA-DP gives variable results however is durable. Long waiters for a deceased renal allograft with HLA-DP DSA and a positive FCXM may be considered for transplantation without prior antibody removal.

« Back to 2020 American Transplant Congress