Purpose: De novo HLA donor-specific antibodies (dnDSA) is common in chronic renal allograft rejection. However, the significance of dnDSA is less clear in the early post-transplant period. We studied the incidence of dnDSA during the first post-transplant year and its association with both acute clinical and subclinical rejection.
Methods: 111 consecutive adult kidney transplant (KT) recipients (excluding primary non-function) on tacrolimus-based triple immunosuppression were studied. Surveillance biopsies at 3, 6, and 12-month were done in addition to indication biopsies for creatinine rise or proteinuria. Biopsies were scored for ABMR and TCMR using Banff 2007 criteria. 62 pts with high immunologic risk (repeat KT, PRA > 20%, African American, or with preformed DSA) also had serial DSA monitoring with solid phase assay with all biopsies. The remaining 49 lower-risk pts had DSA screened only at 12-month. Cumulative incidences (C.I.) of rejection and eGFR at 12-month were compared among groups.
Results: The high-risk group was 50% male, 39% African American, and with mean age of 49 ± 13. 31% were repeat KT, 69% had PRA > 20%, 19% had preformed DSA, and 97% received r-ATG induction. 10 pts developed dnDSA by 12-month (9% overall and 16% of high-risk group), with first detection on post-transplant day 116 ± 129. 3 pts had class I only, 3 had class II only, and 4 had both classes of dnDSA. Among the 12 pts with preformed DSA, 5 had persistent DSA at 12-month, and 3 developed dnDSA against additional specificities. In comparison, no dnDSA was detected in the low-risk group. Recipients with dnDSA had a high C.I. of TCMR of 80% and a lower mean eGFR of 54 ± 16 mL/min at 12-month, significantly different from those with no DSA (Χ2=4.7, p<0.01 and t=2.4, p=0.03 respectively). With the small sample, no outcome differences were seen between those with class I and II dnDSA.
|N||ABMR||Clinical + subclinical TCMR||Graft loss||eGFR (mL/min)|
|Preformed DSA w/o dnDSA||9||3 (33%)||4 (44%)||1 (11%)||71 ± 21|
|dnDSA||10||2 (20%)||8 (80%)||1 (10%)||54 ± 16|
|No DSA||43||1 (2%)*||12 (28%)||1 (2%)||70 ± 25|
Conclusion: A significant proportion of our high-risk pts developed dnDSA by 12-month, in association with high incidences of acute rejection and a lower mean eGFR. Whether these dnDSA persist and affect graft survival will require long-term follow-up.
To cite this abstract in AMA style:Huang Y, Ramon D, Luan F, Samaniego M. Early Emergence of De Novo Donor-Specific Antibody Is Associated with High Incidence of Acute Rejection in Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/early-emergence-of-de-novo-donor-specific-antibody-is-associated-with-high-incidence-of-acute-rejection-in-kidney-transplant-recipients/. Accessed May 7, 2021.
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