Session Name: Histocompatibility and Immunogenetics
Session Date & Time: None. Available on demand.
*Purpose: Data on the role of HLA-DP antibodies on graft outcome is not precise. Studies suggested that the presence of donor-directed HLA-DP antibodies correlate with reduced allograft survival and increased ABMR risk among kidney transplant recipients. We investigated one -year graft outcomes of patients with donor-directed HLA-DP antibodies who received a renal transplant. Primary outcomes included dialysis independence at one-year and rejection (ABMR, TCMR or mixed).
*Methods: Retrospective data were collected on 22 Kidney Transplant recipients who had donor-directed HLA-DP antibody at the time of transplantation
*Results: We identified 22 patients. Induction IS: Basiliximab 6; Alemtuzumab 11; Unknown 5 Maintenance IS Myfortic, and Tacrolimus or Myfortic, Tacrolimus and Prednisolone.19 patients had deceased donor, and 3 patients had a live donor transplant. The majority of our patients were highly sensitised (cRF>85%) pre-transplant 81% (n=18). 18% (n=4) patients were not mismatched at HLA A, B, and DR. 68% were at their 2nd or 3rd transplant. At 1-year post-transplant, 68% (non-censored for death) had a working graft (defined as dialysis independent regardless of eGFR). Graft losses were due to rejection (1), surgical complication (1), unknown (2) and death with a functioning graft (4). A majority of 13 (59%) had DGF, and six patients had a biopsy in the first-week post-transplant (ATN- 5 and acute vascular rejection-1). 72%(n=16) had donor-directed HLA-DP antibody MFI > 5000 at the time of transplantation;63% (n=14) had a positive FCXM at the time of transplantation. Post tx only 10% had an increase in DP DSA MFI, 68% MFI remained the same or decreased, 23% became negative. 32% (n=7) had a biopsy-proven rejection. The majority 5 out of 7 being ABMR
*Conclusions: Most of our patients were highly sensitised and at their 2nd or 3rd transplant. Even though 63% had positive FCXM at the time of transplantation, the rate of rejection was 32%. Most rejections were ABMR. At 1-year post-transplant, 68% of the patients were dialysis independent. Our centre experience suggests that KTx across DP DSAs with +/-ve FCXM could be a feasible option for carefully selected, highly sensitised patients who otherwise may not find a compatible donor.
To cite this abstract in AMA style:Piscoran O, Worthington J, Dhillon R, Augustine T, Picton M, Morton M, Bhutani S. Anti-HLA-DP Antibodies Positive – A Retrospective Review of Outcomes in Renal Transplantation- Single Centre Experience [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/anti-hla-dp-antibodies-positive-a-retrospective-review-of-outcomes-in-renal-transplantation-single-centre-experience/. Accessed June 13, 2021.
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