*Purpose: Patients with preformed DSA are at higher risk of developing acute antibody-mediated rejection (ABMR) after kidney transplantation.

*Methods: We analyzed consecutive kidney transplant recipients (RTR) with pretransplant negative DSA for loci A, B and DR and negative cytotoxicity crossmatch from May 2017 to November 2018 in a single center cohort. All patients received induction therapy with single 3mg/Kg dose rATG and maintenance immunosuppression with tacrolimus, sodium mycophenolate and prednisone. Additional test for anti C, DQ and DP DSA was performed in sensitized patients (Panel Reactive Antibody>0) followed by flow cytometry cross match (FCXM). Patients with positive FCXM received complementary induction with 5 sessions of plasmapheresis (PF) and IVIG, according to the type and strength of DSA. This preliminary analysis describes the incidence of treated acute rejection (tRA) during the first year of transplantation.

*Results: From May 15, 2017 to November 28, 2018, 1.464 kidney transplants were performed. Of these, 59 patients (4%) had a first post-transplant day DSA >1.500 for loci C, DQ or DP. Median class I and class II PRA was 59% and 27%. The FCXM was T-/B- in 32 (54.2%), T-/B+ in 21 (35.6%) and T+/B+ in 6 (10.2%) patients. Nine (43) patients with T-/B+ and 1 (17%) patients with T+/B+ received PF+IVIG. AMBR occurred in 1 patient with T-/B- and in 1 patient with T+/B+. Overall incidence of tRA was 16% for T-/B- (1 clinical, 2 borderline, 1 1A and 1 ABMR), 38% for T-/B+ (2 clinical, 6 borderline), and 33% for T+/B+ (1 borderline and 1 ABMR).

*Conclusions: This analysis suggests that DSA screening followed by FCXM allows the use of individualized reduced intensity induction therapy.

« Back to 2020 American Transplant Congress