Introduction: Role of IgG antibodies against donor human leucocyte antigens (HLA) is established in renal transplant monitoring. Role of IgM donor HLA specific antibodies (DSA) is not clear, especially in highly sensitised patients.This study determined if additional post-transplant monitoring of IgM DSA predicts rejection episodes/graft survival. Methods: Samples from 92 patients were tested on post transplant days 7, 14 and 30 using Luminex microbead assay. IgM MFI values of >2000 were classed as positive. Results were correlated with antibody mediated rejection[(AMR) within day 30 post transplantation] and graft failure. Fischer exact 2 tailed test and Kaplan Meier survival analysis were performed.

Results: IgM levels the peaked at day 14 similar to IgG DSA levels.IgM DSA was positive in 32 patients (35%) of which 17 patients had AMR. IgM was negative in 29 patients who had rejection. IgM DSA was not associated with rejection (P=0.83). However, post-transplant IgM is associated with predicting graft survival (p=0.37); particularly day 14 post-transplantation (p=0.008) Discussion: This study shows additional value of post-transplantation IgM DSA measurement over and above IgG in prediction of death censored graft survival. The IgM monitoring did not predict episodes of antibody mediated rejection.This finding needs to be validated in multi-variate analysis and larger cohort in a multi-centre study.

CITATION INFORMATION: Babu A, Androeu A, Daga S, Higgins R, Mitchell D, Briggs D, Khovanova N, Krishnan N. Donor HLA Specific IgM Antibody Measured on Day 14 Post-Transplantation Predicts Poor Graft Survival in HLA-Incompatible Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).

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