Deceased Donor HLA Antibody Incompatible Renal Transplantation Without Antibody Removal: High Incidence of Acute Rejection Reduced By T-Cell Depleting Induction Therapy
1Division of Renal Medicine, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
2Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Meeting: 2015 American Transplant Congress
Abstract number: C100
Keywords: HLA antibodies, Induction therapy, Kidney transplantation, Rejection
Session Information
Session Name: Poster Session C: Kidney Immunosuppression: Desensitization
Session Type: Poster Session
Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Aims: Screening for HLA-specific antibodies (Ab) is routine for patients on kidney transplant waiting lists, and HLA antigens to which a patient has detectable Ab are listed as 'unacceptable'. Whilst this approach is effective in preventing a positive crossmatch (XM) following allocation, it also precludes the offer of organs to sensitized patients. Here we describe our experience of deceased donor (DD) renal transplantation knowingly performed in the presence of donor-specific anti-HLA Ab (DSA).
Methods: 37 patients received HLA Ab-incompatible (HLAi) DD transplants – either because the threshold for 'unacceptable' for any HLA specificity was increased to a Luminex® MFI >3000 (n=21), or patients known to have anti-HLA-DP Ab (n=16). Complement-dependent cytotoxicity crossmatch (CDC-XM) using a current serum sample was negative in all patients. Flow cytometry B-cell crossmatch (FC-BXM) was positive in 17 (46%). Mean DSA MFI was 5240 (range 872-16356) and mean follow-up length was 32.1 months (range 2-75). All episodes of antibody-mediated rejection (AMR) and T cell-mediated rejection (TCMR) were analyzed.
Results: All patients received tacrolimus, MMF and prednisolone. Induction agents used were basiliximab (n=15) and alemtuzumab (n=22). No planned Ab removal was used. Death-censored 1 year graft survival was 96.3% (26/27 patients). Acute rejection (AR) was significantly more common in those receiving basiliximab compared to alemtuzumab (67% (10/15: 4 with TCMR and 6 with AMR) versus 23% (5/22: 1 with TCMR and 4 with AMR) respectively, p=0.008). Episodes of AMR were treated with plasma exchange. Mean serum creatinine was 1.65mg/dL at 1 year (n=26). There were 4 deaths and 2 graft losses.
Conclusions: HLAi DD renal transplantation is associated with a high incidence of AR, with AMR in 27% of patients despite negative CDC-XM. Our experience suggests that T-cell depleting induction is beneficial and that donor HLA-DP genotyping should be routine practice. In view of the high rate of AR and limited potential for prospective antibody removal in the context of deceased donor transplantation, consideration should be given to the use of novel therapeutics such as eculizumab which has been shown to decrease the incidence of early AMR.
To cite this abstract in AMA style:
Jolly E, Taylor C, Morgan H, Peacock S, Clatworthy M, Torpey N. Deceased Donor HLA Antibody Incompatible Renal Transplantation Without Antibody Removal: High Incidence of Acute Rejection Reduced By T-Cell Depleting Induction Therapy [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/deceased-donor-hla-antibody-incompatible-renal-transplantation-without-antibody-removal-high-incidence-of-acute-rejection-reduced-by-t-cell-depleting-induction-therapy/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress