Background: Immunologic risk monitoring of recipients of kidney transplant(Tx) using donor specific antibodies (DSA) has become a standard practice in most Tx centers in the USA. There is however paucity of data on the incidence and clinical complications associated with recurrence (R'DSA) of preformed or Denovo DSA (DnDSA) in kidney Tx patient receiving early steroid withdrawal Immunosuppression(IS) regimen.

Methods: A prospective monitoring of DSA after kidney Tx was done on patient who consented to study protocol between 2009 and 2011 at Indiana University Tx Program. Patient were evaluated for DSA at 3^rd, 6^th, 9th and 12^th month respectively and then yearly for a total of 3 years. Patient with history of positive flow cytometry crossmatch were excluded. Patients received anti- thymocyte globulins with pulse steroid induction (Early five days withdraw) except zero mismatches living donor recipients who received basiliximab. Patients were placed on steroid free two drugs IS regimen. DSA were checked using single antigen beads (One Lambda Inc).

Results: A total of 170 patients were included in the final analysis over a study period of 8.5 years. Mean follow up time was 5.9 years. One Yr. Incidence of R'DSA alone, DnDSA alone or concurrent R'DSA+DnDSA were 10%, 14.7% and 8.8% respectively. One YR rejection incidence in patients with R'DSA alone vs DnDSA alone vs concurrent R'DSA+DnDSA were 5.9% vs 20% vs 46.7% compared to 9.7% in patients negative for DSA in the first year(p<0.005). Graft survival over study period were 94.1% vs 92% vs 40% vs 92%(p< 0.005) in the R'DSA alone, DnDSA alone or concurrent R'DSA+DnDSA and No DSA group respectively. There was no significant difference in patient survival or 5 years Mean eGFR irrespective of their DSA status (p=0.014 and p=0.379 respectively).

Conclusion: Kidney Tx recipient on steroid free IS with a concomitant recurrence of their preformed DSA along with Denovo DSA in the first year of transplantation appears to be at greater risk for acute rejection and graft loss.

CITATION INFORMATION: Adebiyi O., Taber T., Goggins W., Mishler D., Yaqub M., Sharfuddin A. Clinical Impact of Denovo or Recurrent Donor Specific Antibodies in the First Year Post Kidney Transplant in Patients on Early Steroid Withdrawal Immunosupression Regimen Am J Transplant. 2017;17 (suppl 3).

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