Calcineurin Inhibitor Withdrawal is the Significant Risk Factor for De Novo DSA Production in Living Donor Kidney Transplantation

T. Hiramitsu¹, T. Tomosugi¹, K. Futamura¹, M. Okada¹, N. Goto¹, S. Narumi¹, K. Uchida², Y. Watarai¹

¹Nagoya Daini Red Cross Hospital, Nagoya Aichi, Japan, ²Masuko Memorial Hospital, Nagoya Aichi, Japan

Meeting: 2020 American Transplant Congress

Abstract number: B-065

Keywords: Antibodies, Kidney, Risk factors

Session Information

Session Name: Poster Session B: Kidney Chronic Antibody Mediated Rejection

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: For the long graft survival in the kidney transplantation, chronic antibody mediated rejection (CAMR) due to the de novo donor specific antibody (dnDSA) is one of the biggest problem. At present, because it is difficult to treat CAMR, prevention of de novo DSA production is important. We investigated the risk factor for dnDSA production in the living donor kidney transplantation.

*Methods: 807 patients underwent living donor kidney transplantation between January 2008 and December 2016. 159 recipients were excluded because of preformed DSA (58 recipients), pediatric transplantation (35 recipients), pancreas transplantation after kidney transplantation (4 recipients), and insufficient data on DSA after transplantation (62 recipients). 648 recipients were enrolled in this study. In 84 out of 648 recipients, dnDSA were identified until December 2018. With cox regression analysis, the risk factors for de novo DSA production were investigated between dn DSA positive and negative groups. Investigated factors were donor characteristics including age and sex, and recipient characteristics including age, sex, hemodialysis vintage, cold ischemic time, past history of transfusion , pregnancy, and transplantation, HLA mismatch, pre-operative Flow PRA results, ABO incompatibility, rituximab induction, splenectomy, pre-operative plasmapheresis, transplantation from first-degree relatives, conversion of calcineurin inhibitor (CNI), conversion of mycophenolate mofetil, mizoribin, and everolimus, CNI used for induction, induction with mycophenolate mofetil, mizoribin, and everolimus, CNI withdrawal, withdrawal of mycophenolate mofetil, mizoribin, and everolimus, and rejection within 6 months after transplantation.

*Results: In the univariate analysis, male recipient, male donor, and CNI withdrawal were the significant risk factors (P=0.020, HR 1.795, 95%CI 1.095-2.942; P=0.027, HR 0.568, 95%CI 0.344-0.938; P<0.001, HR 6.346, 95%CI 2.560-15.730, respectively). In the multivariate analysis, calcineurin inhibitor withdrawal was significant risk factor with P<0.001, HR 6.374, 95%CI 2.567-15.828.

*Conclusions: Calcineurin inhibitor withdrawal was demonstrated to be the significant risk factor for de novo DSA production in living donor kidney transplantation

To cite this abstract in AMA style:

Hiramitsu T, Tomosugi T, Futamura K, Okada M, Goto N, Narumi S, Uchida K, Watarai Y. Calcineurin Inhibitor Withdrawal is the Significant Risk Factor for De Novo DSA Production in Living Donor Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/calcineurin-inhibitor-withdrawal-is-the-significant-risk-factor-for-de-novo-dsa-production-in-living-donor-kidney-transplantation/. Accessed July 3, 2025.

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