Background: BK viremia has been shown to correlate with de novo anti-HLA DSA (dnDSA) in renal transplant patients. However, it is unknown if and how bacterial, fungal, and other opportunistic viral infections correlate with the presence and onset of dnDSA. Herein, we studied dnDSA and its correlation with infection in a consecutively transplanted cohort of patients.

Methods: 128 patients received a transplant between '07 to '10 and were pre-txp IgG DSA(-). All patients had HLA antibody monitoring by single antigen beads pre-txp, post-txp at 1,3,6,9,12 months, and annually, thereafter. All infection data was pulled retrospectively from each patient's medical records.

Results: Of the 128 patients, a total of 81 patients (63%) were positive for bacterial or fungal infection and 47 (37%) had opportunistic viral infections (EBV, CMV, BKV). Overall, urinary tract infections (UTIs) were common (n=74, 58%). 75.7% of UTI (+) patients had recurrent UTIs. 70% of those with an opportunistic viral infection also tested positive for a UTI. Comparing infection rates in patients with dnDSA (n=49), there were significantly higher rates of UTIs, recurrent UTIs, and BKV infections in the dnDSA + patients than in the dnDSA(-) patients (Table). 73% of all bacterial/fungal infections, 55% of UTIs, and 53% of BKV infections occurred prior to dnDSA. Only 10% of patients had an acute rejection episode prior to dnDSA.Conclusions: The dnDSA positive patient is a complicated patient with a higher rate of BKV viremia, UTIs, and more frequent UTIs. This association suggests that studying the patient and the immune response to infections may lead to a better understanding the natural history of alloimmune activation and injury.

CITATION INFORMATION: Brooks A, Rebellato L, Briley K, Bolin P, Kendrick S, Maldonado A, Haisch C, Everly M. De Novo DSA Positivity Is Associated with a Higher Rate of Post-Transplant Bacterial and Viral Infections. Am J Transplant. 2017;17 (suppl 3).

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