Session Time: 3:15pm-4:45pm
Presentation Time: 4:03pm-4:15pm
*Purpose: In renal transplantation, the clinical effects of donor specific antibodies (DSA) against HLA-DP are unclear. We report successful kidney transplants in three highly sensitised individuals with significant HLA sensitisation including donor directed HLA-DP antibody without prior antibody removal. All of our cases had a positive B cell flow cytometric crossmatch (FCXM) and HLA-DP DSA mean fluorescence intensity MFI >20,000 (Luminex SAB).
*Methods: Case Report Case 1 A 68 year old male patient known to be highly sensitized ,with a cRF of 100% from previous two renal transplants with relative mean fluorescence (RMF) of 2.52 and 4.13 for T and B cell respectively (cut off is 1.48 for T cell and 1.88 for B cell), received the third kidney from a donation after brain death (DBD) donor. HLA mismatch was 1.1.1. There was delayed graft function (DGF) with no evidence of rejection on the biopsy. He had a slow improvement of graft function. After two years, he had a marginal increase in serum creatinine (199µmol/L) with estimated glomerular filtration rate (eGFR) 29 mL/min/1.73 m2. Transplant kidney biopsy confirmed transplant glomerulopathy. Kidney function was stabilized on Angiotensin Converting Enzyme Inhibitors and the latest creatinine was 238. Case 2 A 58 year old male patient received a DBD kidney allograft. HLA mismatch was 1.1.0 and RMF of 1.81 and 2.34 for T and B cell respectively. His cRF was 100%. He developed DGF necessitating dialysis. A biopsy on 7th day showed no rejection. Following slow improvement, the patient was discharged on day 14 with good urine output and serum creatinine of 430. His latest serum creatinine was 229 µmol/L (eGFR 26). Case 3 A 53 year old male patient received a second kidney transplant in 2019 from a DBD donor with HLA mismatch of 1.1.1 and RMF 3.3for B cell and had an immediate graft function. On day 10, he had an acute deterioration of creatinine to 295 (eGFR of 20) for which a biopsy was done and showed features of AMR with a brisk rise in DSA’s. Following treatment with plasma exchange, graft function returned to baseline level.
*Results: Stable graft function for all the cases.
*Conclusions: Transplantation of highly sensitized patients with positive FCXM due to HLA-DP gives variable results however is durable. Long waiters for a deceased renal allograft with HLA-DP DSA and a positive FCXM may be considered for transplantation without prior antibody removal.
To cite this abstract in AMA style:Marie Y, Key T, Halawa A. A Single Centre Report of Renal Transplantation Against a Positive Crossmatch Due to HLA-DP Donor Specific Antibodies without Prior Antibody Removal [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/a-single-centre-report-of-renal-transplantation-against-a-positive-crossmatch-due-to-hla-dp-donor-specific-antibodies-without-prior-antibody-removal/. Accessed May 18, 2021.
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