Changes in Donor Specific Antibodies (DSA) First Year After Kidney Transplant (KTX): Implications for Graft Histology and Survival

F. Cosio,¹ C. Schinstock,¹ L. Cornell,³ F. de Teresa,¹ M. Stegall.²

¹Nephrology, Mayo Clinic, Rochester, MN
²Surgery, Mayo Clinic, Rochester, MN
³Pathology, Mayo Clinic, Rochester, MN.

Meeting: 2015 American Transplant Congress

Abstract number: A97

Keywords: Antibodies, Rejection

Session Information

Session Name: Poster Session A: Kidney Antibody Mediated Rejection

Session Type: Poster Session

Date: Saturday, May 2, 2015

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

Introduction. De novo DSA post-KTx is associated with high risk of chronic antibody mediated rejection (cAMR) and reduced graft survival. DSA changes during first year may include: de novo DSA (pre-KTX Neg to 1 year Pos), disappearance of pre-KTx DSA (PosNeg) or persistence of pre-KTx DSA (PosPos). We investigated correlates of each of these DSA changes, cAMR and graft survival.

Methods. Included 603 conventional KTx (Neg Xmatch) between 2005-2010, 65% male, age 53+13, 80% living donors. DSA measured pre and 1 year post-KTx. All patients had post-KTx protocol and/or clinical biopsies used to diagnose cAMR, irrespective of DSA. cAMR was used as a time dependent variable in survival analyses. Follow up: 70+26 months.

Results. Pre-KTx, 64% of recipients had no DSA, 5% were DSA I Pos, 23% DSA II Pos and 9% DSA I & II Pos. Risk of cAMR was associated with pre-KTx DSA II (HR=2.86 (1.46-5.57), p=0.002) or DSA I&II (HR=3.33 (1.51-7.34), p=0.003). Comparing DSA II pre-KTx vs 1 year, 230 recipients (48%) were NegNeg, 103 (22%) NegPos, 46 (10%) PosNeg and 101 (21%) PosPos. Compared to NegNeg, the risk of cAMR increased in NegPos, HR=5.64 (1.72-18.5), p=0.004; PosNeg HR=7.44 (2.01-27.8), p=0.003; and PosPos, HR=14.1 (4.71-42.4), p<0.0001. These associations were independent of HLA DR mismatches (HR=2.98, p<0.0001), acute rejection first year (HR=3.02, p=0.006) and re-transplant (HR=4.97, p<0.0001). De novo DSA (NegNeg vs NegPos) was unexpectedly associated with HLA AB mismatches (HR=1.22, p=0.046) and pre-KTx dialysis (HR=0.51, p=0.007). Thus, pre-emptive recipients had higher risk of NegPos. There were no statistically significant correlates of persistent DSA II (PosNeg vs PosPos). The cumulative incidence of cAMR at 3 and 5 years was 7% and 12% and 72% of cases were diagnosed by protocol biopsy. cAMR was associated with reduced graft survival (HR=6.90 (3.48-13.7), p<0.0001) independent of other factors. cAMR caused 27% of all death-censored graft losses.

Discussion. In conventional KTx there is a clear association between DSA II, cAMR and death censored graft loss. Importantly, this association is relevant whether DSA II is present pre and/or post-KTx. De novo DSA II is more common in pre-emptive KTx recipients perhaps due to persistent immunosuppressive effects of dialysis. cAMR is the single most common cause of KTx losses.

To cite this abstract in AMA style:

Cosio F, Schinstock C, Cornell L, Teresa Fde, Stegall M. Changes in Donor Specific Antibodies (DSA) First Year After Kidney Transplant (KTX): Implications for Graft Histology and Survival [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/changes-in-donor-specific-antibodies-dsa-first-year-after-kidney-transplant-ktx-implications-for-graft-histology-and-survival/. Accessed May 19, 2025.

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