Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*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.
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 July 28, 2021.
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