The reported incidence and risk factors for the development of de novo donor specific antibodies (dnDSA) are variable. Although dnDSA is a negative predictor of graft outcomes, routine monitoring production of DSA is not universally practiced. The purpose of this study was to determine the incidence of dnDSA in kidney transplant recipients when dnDSA is measured for suspected antibody mediated rejection compared with monitoring as part of a protocol.

Methods: This is a single-center retrospective cohort review assessing incidence of the dnDSA development associated with for-cause versus protocol-based antibody measurement. Patient and transplant specific characteristics and short term outcomes were collected for all adult patients who received solitary kidney transplants from January 1, 2010 to December 31st, 2013. All patients had negative flow cytometry crossmatch and no pre-transplant DSA.

Results: Six hundred and forty-four patients were included in the analysis. Protocol DSA monitoring occurred during the last 8 months of the data collection period; prior to the protocol, DSA was only measured if antibody mediated rejection was suspected. De novo DSA was detected in 5 out of 544 patients when measured “for cause” and in 7 out of 100 patients when measured per protocol. Baseline characteristics were similar between groups except for use of T-cell depleting agents. There were no differences in acute rejection or graft function at 6 months post-transplant.

Conclusion: Despite a higher incidence of dnDSA detection in the per protocol group, there were no differences in short-term outcomes between the cohorts. Prospective studies are needed to determine the optimal method for monitoring and managing the development of dnDSA in order to optimize long term patient and graft outcomes.

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