Combined Impact of Pre-sensitization and Delayed Graft Function on Allograft Rejection in Deceased Donor Kidney Transplantation: A Nationwide Cohort Study

H. Lee¹, Y. Park¹, T. Ban², S. Song³, S. Song⁴, J. Yang⁵, C. Ahn⁵, C. Yang¹, B. Chung¹

¹Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s hospital, Seoul, Korea, Republic of, ²Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary’s hospital, Seoul, Korea, Republic of, ³Organ Transplantation Center and Department of Internal Medicine, Pusan National University Hospital, Pusan, Korea, Republic of, ⁴Department of Surgery, Ewha Womans University Medical Center, Seoul, Korea, Republic of, ⁵Department of Nephrology, Seoul National University Hospital, Seoul, Korea, Republic of

Meeting: 2021 American Transplant Congress

Abstract number: 1033

Keywords: Kidney transplantation, Rejection, Sensitization

Topic: Clinical Science » Kidney » Kidney Acute Antibody Mediated Rejection

Session Information

Session Name: Kidney Acute Antibody Mediated Rejection

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: The aim of this study is to investigate whether or not delayed graft function (DGF) and pre-transplant sensitization has a synergistic adverse effect on allograft outcome after deceased donor kidney transplantation (DDKT) using the Korean Organ Transplantation Registry (KOTRY) database, the nationwide prospective cohort.

*Methods: The study included 1,370 cases between May 2014 and June 2019. The cases were divided into 4 subgroups according to pre-sensitization and the development of DGF post-transplant (non-pre-sensitized-DGF(-) (n=1100), non-pre-sensitized-DGF(+)(n=133), pre-sensitized-DGF(-) (n=116), and pre-sensitized-DGF(+) (n=21)). We compared the incidence of biopsy-proven allograft rejection (BPAR), change in allograft function, allograft or patient survival, and post-transplant complications across 4 subgroups.

*Results: The incidence of overall BPAR and acute antibody-mediated rejection (ABMR) was significantly higher in the pre-sensitized-DGF(+) subgroup than in other 3 subgroups. In addition, multivariable analysis demonstrated that pre-sensitization combined with DGF is an independent risk factor for both overall BPAR and acute ABMR (hazard ratio 9.100, p < 0.001). Moreover, DGF and pre-sensitization showed significant interaction with each other (p for interaction < 0.001). Pre-sensitization combined with DGF did not show significant impact on allograft function, and allograft or patient survival.

*Conclusions: In conclusion, pre-sensitization and DGF had a synergistic adverse impact on allograft rejection after DDKT.

To cite this abstract in AMA style:

Lee H, Park Y, Ban T, Song S, Song S, Yang J, Ahn C, Yang C, Chung B. Combined Impact of Pre-sensitization and Delayed Graft Function on Allograft Rejection in Deceased Donor Kidney Transplantation: A Nationwide Cohort Study [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/combined-impact-of-pre-sensitization-and-delayed-graft-function-on-allograft-rejection-in-deceased-donor-kidney-transplantation-a-nationwide-cohort-study/. Accessed June 3, 2025.

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