The purpose of this study was to identify factors that affect the outcome of desensitization. We reviewed antibody and HLA mismatch data from 114 patients who were transplanted with an HLA incompatible donor under a desensitization protocol. Desensitization to remove donor specific antibody (DSA) provides the opportunity for life extending or life saving transplantation for many patients who have willing but incompatible donors. We have successfully transplanted more than 90% of patients treated with plasmapheresis and low dose IVIg to eliminate or reduce DSA. However, not all DSAs are completely eliminated and persistent DSA represents a risk for antibody-mediated rejection. We have previously shown that DSA specificity and strength correlate with DSA persistence. Here we have examined additional factors that correlate with the elimination of all, some, or no DSAs. When comparing patients who eliminated all DSA vs. those who eliminated only some, there were more patients who started with lower level DSA (72% vs 45%, P=0.001); there were more cI DSAs (74% vs 34% P=0.0001); the mean number of DSAs was lower (1.8 vs 3.4 P=0.0001); and there were fewer mean mismatched Ags (5.0 vs 6.2 P=0.01). However, for many factors, patients who eliminated no DSA more closely resembled patients who eliminated all DSA than patients who eliminated only some DSA. The frequency of cI DSA, the number of DSAs, and the mean number of mismatches among patients who eliminated no DSA were comparable to patients who eliminated all DSA and significantly different from those who eliminated only some DSA. These data suggest that in addition to the DSA properties, there may be factors intrinsic to patients that impact response to desensitization.

Numbers in parentheses are the numbers of patients in each category defined by amount of DSA eliminated.

CITATION INFORMATION: Zachary A, Montgomery R, Leffell M. Factors Affecting Desensitization Outcome. Am J Transplant. 2017;17 (suppl 3).

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