Outcomes of Hlai Kidney Transplants in Patients with Cpra 100% After Desensitization

A. A. Vo¹, J. Tang¹, S. Williamson¹, C. Meyers¹, E. Huang¹, X. Zhang², M. Haas³, A. Peng¹, R. Najjar¹, S. Supreet¹, N. Ammerman¹, K. Lim¹, M. Gillespie¹, N. Badash¹, S. Jordan¹

¹Comprehensive Transplant Center, Cedars Sinai Medical Ctr, Los Angeles, CA, ²HLA Laboratory, Cedars Sinai Medical Ctr, Los Angeles, CA, ³Pathology, Cedars Sinai Medical Ctr, Los Angeles, CA

Meeting: 2022 American Transplant Congress

Abstract number: 1023

Keywords: Alloantibodies, Highly-sensitized, Kidney transplantation, Rejection

Topic: Clinical Science » Kidney » 36 - Kidney Immunosuppression: Desensitization

Session Information

Session Name: Kidney Immunosuppression: Desensitization

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: The KAS implementation was aimed at increasing access to kidney transplantation in highly HLA sensitized (HS) patients. However, combining desensitization (DES) + KAS could improve transplant rates and outcomes for the most HS (>99.5%) patients. Here we report outcomes for cPRA 100% sensitized patients transplanted after DES.

*Methods: HS patients underwent DES primarily w. IVIG + anti-CD20 ± PLEX. Unresponsive patients received DES w. anti-IL-6/IL-6R or Daratumumab (anti-CD38). Acceptable CMX criteria for transplantation included: Negative CDC, T&B-FCMX ≤225MCS and DSA ≤10,000MFI post DES. Unacceptable antigens were defined as MFI>15,000. Outcomes included rate of ABMR, patient & graft survival & eGFR @12M. All transplanted HS patients received induction w. alemtuzumab and maintained w. tac/mmf/pred.

*Results: From 12/2018-8/2021, 33 HS patients w. cPRA 100% {G1: cPRA<99.95 (N=29), and G2: cPRA≥99.95 (N=4)} received HLAi transplants (Tx). Briefly, mean time from dialysis to Tx was 72±43M vs. 109±71M and mean time from end of 1^st DES to Tx was 11±14M vs. 23±19M, G1 vs. G2. Mean number of rounds of DES needed was 1.6±0.79 (G1) vs. 2.75±1.5 (G2). DGF was seen in 52% (G1) vs. 100% (G2). FCMX+/DSA+ or FCMX-/DSA+ at Tx were 59% (G1) vs. 100% (G2) (Table 1). Figure 1 shows rejection by FCMX/DSA and by cPRA status. Eight patients (24%) developed AMR or mixed rejection {6 (G1) vs. 2 (G2)}. Patient & graft survival were 97%/93% vs. 100%/100% and eGFR @12M was 66±30 vs. 53±14 ml/min/1.73m², G1 vs. G2, respectively.

*Conclusions: Overall, transplantation in HS patients w. cPRA 100% was associated w. longer time to transplant after 1^st round of DES, higher rate of FCMX+/DSA+ @transplant and >50% w. DGF. Despite higher immunologic risk, patient & graft survival were acceptable and eGFRs were similar to non-HLAi patients @12M. Recent data showed that graft survival @12M for >99.95% patients transplanted with KAS alone was 91.5%. Here, combining KAS+DES may improve outcomes for this high immunologic risk group.

To cite this abstract in AMA style:

Vo AA, Tang J, Williamson S, Meyers C, Huang E, Zhang X, Haas M, Peng A, Najjar R, Supreet S, Ammerman N, Lim K, Gillespie M, Badash N, Jordan S. Outcomes of Hlai Kidney Transplants in Patients with Cpra 100% After Desensitization [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-hlai-kidney-transplants-in-patients-with-cpra-100-after-desensitization/. Accessed November 23, 2024.

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