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Clinical Correlations Associated with Development of De Novo Donor-Specific Antibody in the First Year Following Kidney Transplant at a Single Center

J. M. Zimmerer1, M. Basinger1, B. A. Ringwald1, R. Pelletier2, A. Rajab1, A. El-Hinnawi1, M. Abdel-Rasoul1, K. Washburn1, G. L. Bumgardner1

1Ohio State University, Columbus, OH, 2Robert Wood Johnson Barnabas Health, New Brunswick, NJ

Meeting: 2020 American Transplant Congress

Abstract number: C-337

Keywords: Infection, Outcome, Rejection

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session C: Biomarkers, Immune Assessment and Clinical Outcomes

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

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

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  • Prospective Monitoring of De Novo Donor-Specific Antibodies: Incidence, Clinical Outcomes and Dynamic Changes Over 5 Years After Kidney Transplantation.

*Purpose: The development of de novo donor-specific antibody (dnDSA) portends inferior long-term graft survival. This study investigates the short-term clinical correlations associated with dnDSA that develops within the first year after kidney transplant (KTx) at a large volume transplant center.

*Methods: We prospectively monitored 95 first time KTx recipients (53.3±11.8 years old, 41% female, 21% African American, 32.6% deceased donor recipient) for development of dnDSA at 1, 3, 6, 9 and 12-months posttransplant using single antigen beads (One Lambda) and Luminex technology (MFI >2000). We analyzed immunosuppression (IS) levels, occurrence of acute cell mediated rejection (CMR) and antibody mediated rejection (AMR), infections, graft function/survival, and hospital readmissions within the first-year post transplant. All recipients received the same IS regimen [anti-lymphocyte induction therapy, 5-day steroid taper, and dual maintenance IS with a calcineurin inhibitor (CNi) and mTORi].

*Results: Twenty-three recipients (24.2%) developed dnDSA within 1-year posttransplant. There was no difference in IS levels throughout the first-year posttransplant between DSA-positive and DSA-negative recipients [both groups achieved similar target levels of CNi (760±42 ng/mL) and mTORi (7.5±0.3 ng/mL), p=ns]. The overall rate of biopsy proven acute rejection was 10.5% (10/95), which included CMR (n=5), AMR (n=1), or combined CMR and AMR (n=4). The DSA-positive compared to DSA-negative group had a significantly higher rate of acute rejection [7/23 (30.4%) vs. 3/72 (4.2%); p=0.001] and trended towards greater graft loss [2/23 (8.7%) vs. 0/72 (0%); p=0.056] at 1-year posttransplant. Sixty-seven percent (64/95) of recipients were readmitted to the hospital at least once within the first-year posttransplant, which occurred more frequently in DSA-positive (19/23, 82.6%) compared to DSA-negative recipients (45/72, 62.5%; p=0.004). Among recipients readmitted to the hospital, DSA-positive recipients had more frequent hospital readmissions (4.1±2.9) compared to DSA-negative recipients (2.3±1.5; p=0.002). Overall, 1-year cumulative hospital length of stay was greater in DSA-positive recipients (26.7±9.2 days vs. 10.5±1.9 days; p=0.051). DSA-positive recipients experienced more infections (bacterial and viral) than DSA-negative recipients [14/23 (60.9%) vs. 29/72 (40.3%), p=0.03], which occurred both before (n=8) and after (n=6), but not concurrent with, initial DSA detection.

*Conclusions: Overall, these data underscore that DSA-positive compared to DSA-negative recipients experience higher rates of acute rejection, infection, and hospital readmissions within the first year posttransplant that is not attributable to differences in immunosuppression levels.

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To cite this abstract in AMA style:

Zimmerer JM, Basinger M, Ringwald BA, Pelletier R, Rajab A, El-Hinnawi A, Abdel-Rasoul M, Washburn K, Bumgardner GL. Clinical Correlations Associated with Development of De Novo Donor-Specific Antibody in the First Year Following Kidney Transplant at a Single Center [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-correlations-associated-with-development-of-de-novo-donor-specific-antibody-in-the-first-year-following-kidney-transplant-at-a-single-center/. Accessed March 5, 2021.

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