*Purpose: Patients with high levels of preformed donor-specific antibodies (DSA) are often not considered for kidney transplantation (KT), despite negative CDC-crossmatch, mainly in regions where flow cytometry is not available. This study evaluated the 1-year outcomes of patients with preformed DSA receiving deceased donor (DD) kidneys according to two prophylactic strategies.

*Methods: Single-center retrospective cohort including DD KT recipients with preformed DSA (anti-HLA A, B or DR) >1,500 MFI and negative CDC-crossmatch transplanted between Jan/13 and Apr/17 (n=74). All patients received anti-thymocyte globulin 6mg/kg + tacrolimus + steroids + mycophenolate or mTOR inhibitor. Patients with DSA 1,500-3,000 MFI additionally received IVIG 2g/Kg (IVIG group, n=22). Those with DSA > 3,000 MFI received additional treatment with plasmapheresis (4 sessions) and IVIG 2g/Kg (PF group, n=54).

*Results: Patients were predominantly women (66%), 41±16 years-old, retransplantation in 45%, median Class I/II PRA = 70 (IQR 68) / 25 (IQR 68)%, respectively, and 55 (IQR 59) months on dialysis. 77% received kidneys from standard criteria donors. The main evaluated outcomes are demonstrated in Table 1.

*Conclusions: Despite the high incidence of acute rejection episodes, the tailored additional treatment with IVIG ± PF based on perceived immunological risk was associated with excellent transplant outcomes, suggesting this approach as an option for patients with preformed DSA.

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