Background: Development of anti-HLA donor specific antibodies (DSAs) has been associated with inferior pancreas transplant outcomes. We analyzed data for pancreas and kidney transplant recipients at our institution to assess the frequency and downstream consequences of de novo DSAs in this cohort.

Methods: All patients who underwent a simultaneous pancreas and kidney (SPK) or a pancreas after kidney transplant (PAK) from July 2014 to July 2016 were included in this analysis.

Results: We identified 22 patients who underwent a SPK (n=17) or a PAK (n=5), with a mean age of 45.2 and 38.2 years, respectively. There were 15 men and 7 women. All PAK recipients had had a live unrelated kidney transplant prior to pancreas transplant. Men were more likely to undergo SPK (OR=4.8, p=0.12). PAK recipients had lower mean serum creatinine values (1.3 mg/dL vs.1.9 mg/dL, p=0.3), and lower mean serum lipase levels (238 U/L vs. 315 U/L, p=0.4). All transplant recipients underwent screening studies for de novo DSAs with an average of 3 (range 1-6) screening studies for SPK, and 2 (range 1-3) for PAK subgroups. None of the PAK patients developed de novo DSAs while 4/17 (23.5%) SPK patients were noted to have a de novo DSA (RR=0.72; 95%CI=0.54-0.96, p=0.32). SPK recipients with HLA class II antibodies were more likely to have serum lipase levels above 500 U/L (RR=1.4, 95%CI=0.9-2.1, p=0.08). Fifteen patients underwent at least one kidney biopsy (range 0 to 3) for indication or surveillance but only one patient developed acute kidney allograft rejection due to non-compliance. There were no graft failures during the observation period.

Conclusions: SPK recipients with de novo anti-HLA class II DSAs had a higher likelihood of serum lipase levels above 500 U/L which could be an indicator of a subclinical immunological response in the pancreas allograft. Elevated serum lipase levels could be surrogate for anti-HLA DSA activity in the SPK cohort. Pancreas transplant recipients with unexplained elevated serum lipase levels could be considered for DSA monitoring to exclude activation of antibody mediated responses. Additional data with longer term follow-up would be required to further establish this relationship for clinical applications.

CITATION INFORMATION: Javaid B, Raza T, Abrams P, Ghasemian S, Moore J, Gilbert A, Grafals M, Verbesey J, Cooper M. Elevated Serum Lipase Levels in Simultaneous Pancreas and Kidney Transplantation May Indicate Anti-HLA Donor Specific Antibody Response. Am J Transplant. 2017;17 (suppl 3).

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