Introduction: although the development of donor-specific antibodies (DSAs) is a known event after allograft nephrectomy (Nx), there are few studies describing the tempo, class and predictors of DSAs development in patients after graft failure undergoing Nx.

Methods: Anti-HLA antibodies were assessed for class I and class II HLA (DSA number and PRA) at the time of graft Nx/failure and 3, 6, 12 and 24 months using a single antigen Luminex assay. A mean fluorescence intensity value >1,000 was considered positive.

Results: only patients with a first failed graft and undetectable DSAs at the time of graft Nx/failure were considered for the analysis. 63 patients (Nx+) underwent Nx and 49 patients whose grafts failed, but were not nephrectomised (Nx-) acted as controls. Tacrolimus (tac) was discontinued at the time of Nx in 51/63 and by 3 months after Nx in 12/63 patients, whereas it was continued in 47/49 and suspended 6 to 12 months after failure in 2/49 Nx- patients. The Figure shows that DSA formation (class I, II and I+II) was significantly greater (p<0.001) in Nx+ group compared with the Nx- group and DSA formation was delayed in the Nx- group. Tac withdrawal in both groups was associated with an increased incidence of DSA production (p<0.001 at all time points).

Discussion and Conclusions: Graft Nx is followed by significant and continuing DSA production compared with Nx- patients. However Nx- patients do develop DSAs 6-24 months after graft failure, albeit less frequently. These results suggest that Nx and Tac withdrawal for non essential reasons should be avoided particularly in patients suitable for retransplantation.

CITATION INFORMATION: Lucisano G, Brookes P, Santos-Nunez E, Firmin N, Gunby N, Hassan S, Gueret-Wardle A, Willicombe M, Taube D. De Novo Donor-Specific Antibodies After Allograft Nephrectomy. Am J Transplant. 2017;17 (suppl 3).

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