Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: To evaluate the effectiveness of rituximab as induction therapy for pts undergoing kidney transplant (Tx) with historic DSA (hDSA) [Desens. Light].
*Methods: 104 consecutive pts that were transplanted across hDSA and received one dose of rituximab as induction were included [mean follow-up of 4.3y (±2), 94% had biopsies, 86% received CNI-based immunosuppression (Tac+MMF). General characteristics, Table 1]. Clinical information was obtained from the medical record; biopsies and graft failure were evaluated for each pt. Historic, recurrence of, and de novo DSA were classified as weak (w, 1:2-1:4 titer), weak/moderate (w/m, 1:8-1:16), moderate (1:32-1:128) or strong (>1:128). Cox regression analyses were used to determine the association of pre-Tx DSA with post-Tx DSA and clinical outcomes.
*Results: This cohort displayed 20 (19%) pts with biopsy proven TCMR and 14 (13%) with ABMR.Recurrence of hDSA Class I was found in 29 pts, 22 for Class II. At least one de novo DSA Class I was detected in 23 pts, and Class II in 20 pts.Peak strength of the historical DSA was used as basis for the following correlations. Univariate analysis of both class I and class II antibodies demonstrated that pts with hDSA w/m have a higher rate of recurrence compared with hDSA w (p=0.033). Importantly, when analyzed per class of antibodies, historical w/m class II DSA showed increase significance (p=0.011), which class I hDSA were no longer associated with DSA recurrence. Risk analysis demonstrated that pts with hDSA w/m have a higher risk of recurrence than those with DSAw only, in spite of the rituximab dose (p=0.003, Figure 1). Subsequent analysis indicated also a higher risk of de novo DSA in the hDSA w/m group (p=0.014).
*Conclusions: Our data suggest that the effectiveness of rituximab to prevent recurrence of antibodies is dependent on the original antibody strength. Therefore, the strength of the hDSA, especially Class II, can serve to risk stratify pts to those that may benefit from rituximab and those that may require additional treatment.
To cite this abstract in AMA style:Casillas-Abundis A, Tambur A, Shetty A, D'Agostino C, Leventhal JR. “Desens Light”: Single Center Experience Using Rituximab for High Immunologic Risk Kidney Transplant Recipients with Historic DSA [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/desens-light-single-center-experience-using-rituximab-for-high-immunologic-risk-kidney-transplant-recipients-with-historic-dsa/. Accessed July 7, 2020.
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