Both Preformed and De Novo Cw Donor Specific Antibodies Are Clinically Significant in Renal Transplantation
Imperial College Kidney and Transplant Centre, Imperial College NHS, London, United Kingdom.
Meeting: 2015 American Transplant Congress
Abstract number: B282
Keywords: HLA antibodies, Kidney transplantation
Session Information
Session Name: Poster Session B: Vascularized Composite Tissue Allografts and Xenotransplantation
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Preformed [PF] and de novo [DN] anti-HLA A, B, DR and DQ donor specific antibodies [DSAbs] are associated with poorer allograft outcomes secondary to antibody mediated injury. Although PF Cw DSAbs occurring in isolation are associated with rejection, the significance of DN Cw DSAbs is uncertain. In this study we describe the clinical importance of both PF and DN isolated Cw DSAbs.
1273 CDC/FCXM negative renal transplant recipients [mean follow up 4.46 ± 2.50 yrs] receiving a steroid sparing, tacrolimus based maintenance regimen with monoclonal antibody induction were studied. Patients were screened for DSAb pre-transplant and post transplant at months 1, 3, 6, 12 and then yearly and at times of allograft dysfunction.
67/1273[5.3%] patients had a Cw DSAb of which 28/67[41.8%] occurred in isolation [13 PF, 15 DN]. Compared with the sensitised [S][HLA+,DSAb-] and non-sensitised [NS] groups, patients with PF Cw DSAb [Cw] were more likely to develop rejection and transplant glomerulopathy [TG] as shown below in table one. The development of DN Cw DSAbs was associated with inferior allograft survival, AMR free survival and TG free survival.
| Survival | Preformed Group | De Novo | ||||||
| NS | S | Cw | p value | No DSA | Cw | p value | ||
| Allograft | 79.5 | 85.8 | 90.0 | 0.95 | 85.2 | 76.2 | 0.029 | |
| Rejection | 74.2 | 72.9 | 31.3 | 0.0021 | 80.2 | 80.0 | 0.55 | |
| ACR | 80.9 | 78.9 | 55.9 | 0.03 | 81.8 | 93.3 | 0.45 | |
| AMR | 91.1 | 89.1 | 76.4 | 0.11 | 98.2 | 86.7 | 0.0003 | |
| TG | 92.9 | 91.3 | 0 | 0.0003 | 97.1 | 85.6 | 0.0003 | |
This study shows that both PF and DN Cw DSABs are clinically significant. Patients with these antibodies may benefit from increased surveillance and immunosuppression.
To cite this abstract in AMA style:
Gueret-Wardle A, Willicombe M, Dibbur V, Brookes P, McLean A, Taube D. Both Preformed and De Novo Cw Donor Specific Antibodies Are Clinically Significant in Renal Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/both-preformed-and-de-novo-cw-donor-specific-antibodies-are-clinically-significant-in-renal-transplantation/. Accessed November 23, 2024.« Back to 2015 American Transplant Congress