Calcineurin Inhibitor Dose and Selection, Not Antiproliferatives or Steroids, Influence Development of DSA One Year Post-kidney Transplant

M. Henderson¹, G. Morris², L. Awdishu¹, K. Fabbri¹, M. Shah³, A. Khan³, J. Kerr¹

¹Pharmacy, University of California San Diego Health, San Diego, CA, ²Pathology, University of California San Diego Health, San Diego, CA, ³Nephrology, University of California San Diego Health, San Diego, CA

Meeting: 2021 American Transplant Congress

Abstract number: 933

Keywords: HLA antibodies, Immunosuppression, Kidney, Risk factors

Topic: Clinical Science » Kidney » Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Information

Session Name: Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Allograft rejection is a serious complication in kidney transplantation (KT). Despite advances in immunosuppression, acute rejection remains a concern in the first year of transplant. The incidence of donor-specific antibody (DSA) formation in approaches, such as steroid minimization, is undefined.

*Methods: This retrospective, single center study, included patients who received KT between January 2017 and November 2019. Renal function, DSA formation, monthly median calcineurin inhibitor (CNI) levels, duration of goal dosing antiproliferatives, and monthly median steroid doses were recorded. DSAs were measured using single-antigen bead immunoassay with cutoff of 3000 MFI. The primary outcome was incidence of DSA formation within one year post KT. Secondary outcomes included incidence of DSA formation in patients on steroid minimization protocol, time at goal dose antiproliferatives, and trends in CNI concentrations.

*Results: Patients (n=167) were followed for one year post KT. All patients received anti-thymocyte globulin (ATG) induction therapy (median dose of 4.2 mg/kg). Twenty-three (8%) patients developed DSA and median time to formation was 28 days (IQR 71 – 12). DSAs were predominantly against HLA Class II (78%). DSA formation did not differ based on ATG dose. At 3 months post KT, 33 patients (19%) were off steroids and did not develop DSA. There was no difference in incidence of DSA based on time at goal dose antiproliferatives. Twenty-seven patients transitioned from tacrolimus (FK) to cyclosporine (CsA) and 37% developed DSA compared to 9% in patients that remained on FK (P<0.001). Patients with DSA were less likely to be at goal dosing of CNI within the first month post KT (27% versus 55%; P = 0.02).

*Conclusions: In summary, preventing DSA formation appears to be primarily influenced by CNI selection and levels. Steroid minimization or goal antiproliferative dosing had no effect on DSA. Critically, our data emphasize the importance of maintaining adequate CNI levels and caution when transitioning from FK to CsA.

To cite this abstract in AMA style:

Henderson M, Morris G, Awdishu L, Fabbri K, Shah M, Khan A, Kerr J. Calcineurin Inhibitor Dose and Selection, Not Antiproliferatives or Steroids, Influence Development of DSA One Year Post-kidney Transplant [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/calcineurin-inhibitor-dose-and-selection-not-antiproliferatives-or-steroids-influence-development-of-dsa-one-year-post-kidney-transplant/. Accessed May 16, 2025.

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