Session Time: 4:00pm-5:30pm
Presentation Time: 5:00pm-5:12pm
Location: Room 115-C
INTRODUCTION: Antibody mediated rejection (AMR) is one of the causes of dysfunction and graft loss. The limited histological features, with a weak sensibility of c4d, make his diagnosis and prognosis difficult. The detection of intra-graft DSA (gDSA) could be a diagnostic and prognostic tool of AMR.
METHODOLOGY: We looked for gDSA in 7 heart transplanted (HT) recipients (15 biopsies) of whom 6 are sensitized, and 11 lung transplanted (LT) recipients (13 biopsies) of whom 8 are sensitized (sDSA+). AMR was defining by graft dysfunction and/or histological features of rejection and sDSA+. gDSA were identified by Luminex SA assay on HT and LT biopsies eluates.
RESULTS: In HT recipients, 6 of the 15 HT biopsies have AMR and 8 have some gDSA. The concordance level between sDSA and gDSA is 60% (6 sDSA+/gDSA+). None of the gDSA+ patients is sDSA-. There is an 80% concordance level between gDSA and rejection (6 gDSA+/RH+, 6 gDSA-/RH-). The single case gDSA-/RH+ come from a small size of the biopsy and has a low MFI level of sDSA. The 2 cases gDSA+/RH- come from the same recipient without graft dysfunction. One of the 2 HT biopsies precedes rejection of 2 months. Among 3 patients biopsied later, we note 1 case of gDSA negativation.
In LT recipients, there are 6 cases of AMR from the 13 LT biopsies. The concordance between sDSA and gDSA is 77% (6 sDSA+/gDSA+) and 100% between gDSA and AMR. Among the 7 gDSA- cases, we note 3 cases of cellular rejection (sDSA-) and 3of pneumonia. Four gDSA+ patients evolved to chronic humoral rejection (n=3) and/or death (n=3). Among the 2 patients biopsied later, we note 1 case of gDSA positivation.
CONCLUSION: gDSA are detected in 86% of AMR+ in HT biopsies and 100% in LT biopsies of sDSA+ patients. They are a witness of the interaction between sDSA and the graft endothelium. They could represent an argument for AMR diagnosis and could have a prognosis value that should be confirmed by a prospective study.
To cite this abstract in AMA style:Olagne J, Parissiadis A, Froelich N, Caillard S, Chenard M-P, Epailly E, Kremer H, Degot T, Hirschi S, Kessler R, Moulin B. A New Diagnostic Tool for Antibody Mediated Rejection in Heart and Lung Transplantation: Intragraft Donor Specific Anti-HLA Antibodies Detection [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/a-new-diagnostic-tool-for-antibody-mediated-rejection-in-heart-and-lung-transplantation-intragraft-donor-specific-anti-hla-antibodies-detection/. Accessed March 26, 2019.
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