Predicting the Timing of Graft Failure in De Novo DSA Positive Patients.

M. Everly,¹ L. Rebellato,² C. Haisch,² K. Briley,² P. Bolin,² S. Kendrick,³ C. Morgan,² A. Maldonado,⁴ A. Nguyen,¹ P. Terasaki.¹

¹Terasaki Foundation Laboratory, Los Angeles
²East Carolina University, Greenville, NC
³Eastern Nephrology Associates, Greenville, NC
⁴Vidant Medical Center, Greenville, NC.

Meeting: 2016 American Transplant Congress

Abstract number: 503

Keywords: Alloantibodies, Survival

Session Information

Session Name: Concurrent Session: Kidney Transplant Recipient: Long Term Outcomes Session 2

Session Type: Concurrent Session

Date: Tuesday, June 14, 2016

Session Time: 4:30pm-6:00pm

Presentation Time: 4:30pm-4:42pm

Location: Ballroom A

The risk of graft failure after de novo DSA (dnDSA) is not always immediate. To make more informed therapeutic decisions in dnDSA+ patients, we need to better identify what characteristics correlate with the timing of graft failure (early, intermediate, and late post-dnDSA).

Methods:We performed a single center study of 99 dnDSA (+) patients receiving a primary transplant between 3/99 – 12/10 that had 3 years of post-dnDSA follow-up. All patients had HLA antibody monitoring by single antigen beads pre-txp, post-txp at 1,3,6,9,12 months, and then annually. IgG3 subclass testing was performed. All patients were pre-txp DSA (-).

Results: Early post-dnDSA graft failure (<1 year post-dnDSA) was triggered by non-adherence (p<0.01 vs grafts surviving beyond 1 year post-dnDSA, Fig B). The early graft failure group's profile at dnDSA onset had higher rates of IgG3 dnDSA, HLA Class I + II dnDSA, and serum creatinine >2 mg/dL. The intermediate graft failure group (n=17) was compared to the group with good graft function at least 1-3 years post-dnDSA (n=70) (Fig C). The intermediate graft failure patients had a higher rate of BK viremia (p=0.02). The development of IgG3 dnDSA by 1 year post-dnDSA occurred in twice as many intermediate graft failure patients [HR 3.4, 95%CI 1.2-9.0]. Additionally, acute rejection by 1 year post-dnDSA (HR 5.0, 95% CI 1.9-13.7) and >25% eGFR decline at 1-year post-dnDSA (compared to eGFR at dnDSA onset, HR 6.5, 95% CI 2.4-17.5) predicted graft failure between 1 – 3 years post-dnDSA. The late graft failure group (n=15) was compared to dnDSA + grafts functioning > 3 years post-dnDSA (n=58). Acute rejection by 1 year post-dnDSA and IgG3 dnDSA by 1 year post-dnDSA were good predictors of late graft failure. In late graft failure, 87% eventually developed IgG3 (vs 21% in. long-term function grafts).

Conclusions: Patient and dnDSA characteristics can help determine the fate of the graft following dnDSA appearance.

CITATION INFORMATION: Everly M, Rebellato L, Haisch C, Briley K, Bolin P, Kendrick S, Morgan C, Maldonado A, Nguyen A, Terasaki P. Predicting the Timing of Graft Failure in De Novo DSA Positive Patients. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Everly M, Rebellato L, Haisch C, Briley K, Bolin P, Kendrick S, Morgan C, Maldonado A, Nguyen A, Terasaki P. Predicting the Timing of Graft Failure in De Novo DSA Positive Patients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/predicting-the-timing-of-graft-failure-in-de-novo-dsa-positive-patients/. Accessed May 21, 2025.

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