Session Time: 6:00pm-7:00pm
Presentation Time: 6:10pm-6:15pm
*Purpose: The number of sensitized kidney transplant recipients (KTRs) are increasing on the waiting list. Some KTRs receive an organ in the presence of pretransplant (pre-TX) donor-specific antibodies (DSA). After the transplant, these DSAs become undetectable (UD) in some KTRs, while in others the DSA remain detectable. Outcomes of KTRs with detectable (DT) vs UD pre-Tx DSA are unknown
*Methods: We analyzed all KTRS transplanted at our center between 01/2013 and 06/2017 who had pre-transplant DSA with MFI of > 500, excluding DSA against Cw. KTRS were divided into two groups based on the DSA level at 3 months post-transplant as DT and UD. Patients were followed untill death or death censored graft failure (DCGF). Any acute rejections (AR) during the follow-up period were outcomes of interest.
*Results: Of 1237 KTRS during the study period, 102 fulfilled our selection criteria, 53 in the DT and 49 in the UD group. Most of the baseline characteristics were similar between the groups, including KTRs with cPRA > 20% and the level of pre-Tx DSA MFI. Post-transplant follow up was similar between the groups (DT, 56.8 mo vs UD 60.8 mo, p=0.52). 26% in the DT group and 20% in the UD developed denovo DSA (dnDSA) during the study period. Similarly, 38% ( 13% within 3 mo, 26% within 1 year of transplant) in DT and 30% (8% within 3 months, 20% within 1 year of transplant) in UD developed acute rejection, mainly antibody-mediated rejection, without any statistical difference (p=0.61). There were no differences in the number of for-cause biopsies between the groups or graft function at various times. At last follow up, 21% of the DT group ( 11% DCGF) and 20 % of the UD (12% DCGF) had graft failure. In the multivariate analysis, detectable pre-tx DSA at 3 months was not significantly associated with the risk of rejection ( HR: 1.17, 95% CI: 0.60-2.32, p=0.63). The only variable associated with increased risk of rejection was dnDSA ( HR: 2.82, 95% CI: 1.42-5.58).
*Conclusions: Disappearance of pre-transplant DSA at 3 months after kidney transplant was not associated with better outcomes. 20% had acute rejection within 1 year of transplant despite undetectable DSA at 3 months. Close follow-up is needed in these high immunological risk KTRs.
To cite this abstract in AMA style:Parajuli S, Djamali A, Kharel A, Alzoubi B, Bath N, Garg N, Aziz F, Mandelbrot D. Among Patients with Pre-Transplant Donor-Specific Antibodies, the Disappearance of the Donor-Specific Antibodies at 3 Months is Not Associated with Less Rejection [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/among-patients-with-pre-transplant-donor-specific-antibodies-the-disappearance-of-the-donor-specific-antibodies-at-3-months-is-not-associated-with-less-rejection/. Accessed September 21, 2021.
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