Donor Specific Antibodies (DSA) Increase the Risk for Rejection After Pancreas Transplantation Qithout Negatively Impacting Survival
Multi-Organ Transplant, University Health Network, Toronto, ON, Canada.
Meeting: 2015 American Transplant Congress
Abstract number: 233
Keywords: Pancreas transplantation
Session Information
Session Name: Concurrent Session: Optimizing Immunosuppression in Pancreas Transplantation
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 3:27pm-3:39pm
Location: Room 119-B
Donor-specific antibodies (DSA) have been associated with increased rejection and lower kidney transplant survival. The impact of DSA on pancreas transplant outcomes in patients with negative T-cell cytotoxicity cross-matches remains unclear. We performed a retrospective analysis of DSA in 171 (69 PAK and 102 SPK) consecutive pancreas transplants from a single center since January 2009, when routine DSA examination using luminex single antigen assays began. Pre-transplant DSA (Pre-DSA) was detected in 36 (21%) recipients, and was more prevalent in PAK than SPK recipients (32% vs. 16%, p=0.02). All patients with pre-DSA had a negative CDC or flow cross-match and were treated routinely with IVIG during surgery. De novo DSA developed in 44 (33%) recipients during follow-up (33% in PAK vs. 32% in SPK, p=0.89). Kidney and/or pancreas rejection occurred in 25% (42), and most 64% (22) of these occurred in the presence of DSA (p=0.012). The presence of DSA also increased the risk of having > 1 rejection episode (p=0.004). DSA became undetectable in 21 (26%) patients: in 5 patients, the same DSA reappeared in 3 and new DSA developed in 2 (reappearance of DSA was associated with an acute rejection episode in 4 of 5 recipients); in 16 patients in whom DSA remained undetectable, 5 had a subsequent rejection episode with no evidence of new DSA. Pancreas graft survival among those with and without pre-transplant DSA was 92% and 88% at 1-year and 80% and 88% at 3-years (p=0.26). Similarly, pancreas graft survival among those with and without de novo DSA was 86% and 91% at 1-year and 81% and 89% at 3-years (p=0.14). 24 graft failures occurred during follow-up time (9 in the DSA- and 15 in the DSA+), only 6 were due to rejection (3 in the DSA- and 3 in the DSA+; p=0.64). Pre-transplant DSA also did not increase the risk graft loss from rejection (13% in Pre-DSA- and 28% of Pre-DSA+; p=0.57). Conclusion: Pre-transplant DSA with a negative cross-match and post-transplant de novo DSA are risk factors for rejection, but have little impact on early pancreas transplant survival.
To cite this abstract in AMA style:
Marquez M, Dib M, Sapisochin G, Laurence J, Barbas A, Bazerbachi F, Norgate A, Selzner M, Greig P, McGilvray I, Cattal M. Donor Specific Antibodies (DSA) Increase the Risk for Rejection After Pancreas Transplantation Qithout Negatively Impacting Survival [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-specific-antibodies-dsa-increase-the-risk-for-rejection-after-pancreas-transplantation-qithout-negatively-impacting-survival/. Accessed June 2, 2025.« Back to 2015 American Transplant Congress