Introduction

The purpose of this study is to examine the relationship between prolonged ischemia (delayed graft function – DGF) and the development of de novo donor specific antibodies (DSA) following kidney transplantation.

Methods

We performed a retrospective analysis of all patients receiving a kidney transplant at our center since October 2012, when a protocol for routine post-transplant testing for DSA as well as surveillance biopsies was initiated. We excluded patients followed for less than 6 months. DSA testing and percutaneous biopsies were both done for protocol as well as for clinical indications. Patients were defined as having prolonged DGF if they required dialysis for 2 weeks or more, and did not have evidence of any damage beyond ischemia on biopsy.

Results

There were 218 patients analyzed. 42 patients (19.3%) developed de novo DSA following transplant, and 53 (24.3%) experienced DGF following transplantation (see table 1). 19 patients (8.7%) had DGF lasting 2 weeks or more. Among this group with extended DGF, there was an increased rate of development of DSA compared with the control group (36.8% vs 17.6%, p=0.04). We considered whether this result could be explained by delayed initiation of adequate immunosuppression, or changes in induction therapy. Patients with prolonged DGF did not have a statistically significantly longer time to achieve therapeutic immunosuppression, and when analyzed as an independent variable, delay in initiating tacrolimus was not found to be statistically significant for the development of DSA (p= 0.38). There was no statistically significant difference in induction regimens between the groups (p= 0.33).

Conclusions

Prolonged ischemia increases development of de novo antibodies against the allograft. This effect is independent of differences in immunosuppression. Close monitoring of antibody levels is warranted in patients with prolonged ischemic injury following transplantation.

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