Graft Survival in Sensitized and Non-Sensitized Patients: Role of the Combination of Donor-Specific Antibodies and Acute Rejection.

P. Souza,¹ A. Aguirre,¹ G. Bezerra,² H. Rodrigues,² F. Agena,¹ D. David,¹ F. de Paula,¹ E. David-Neto,¹ M. Castro.¹

¹Renal Transplant Service, Hospital das Clínicas de São Paulo, Sao Paulo, Brazil
²Immunology Laboratory, Instituto do Coração (InCor), Sao Paulo, Brazil.

Meeting: 2016 American Transplant Congress

Abstract number: D29

Keywords: HLA antibodies, Kidney transplantation, Rejection, Survival

Session Information

Session Name: Poster Session D: Antibody Mediated Rejection: Session #2

Session Type: Poster Session

Date: Tuesday, June 14, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Background: Sensitized (S) patients have higher risk for acute rejection (AR), especially ABMR. DSA is a risk fator for ABMR, however, its impact on AR incidence within 1^st post-Tx year remains controversial. The aim is to evaluate graft (GS) and patient survival (PS) in non-sensitized and sensitized patients (pts) according to AR occurrence in pts receiving tacrolimus and mycophenolate as immunossupression.

Methods: Unicentric, retrospective study including 1002 isolated kidney recipients > 18yo transplanted between Jan/09-Dec/2013. They were followed for 35mo (12-60mo). Pre-Tx DSA (A/B/DR) was analyzed by single antigen bead and AR by Banff'09. Results: From 1002 pts, 15 had no DSA performed and were excluded. 937 enrolled: majority were male (57%), 1^st Tx (93%), blood transfusion (BT, 53%), pregnancies (74%), deceased donor (63%) and 41% Thymoglobulin as induction. Were subclassified according to pre-Tx calculated PRA as: 744 (75%) non-sensitized (NS;PRA=0%) and 26% (243) sensitized (S;PRA≥1%). Among S pts, 37.5% (91) were pre-Tx DSA⁺ while 62.5% (241) were DSA^–. Overall 1^st year AR incidence was 14.4% (144: 70% TCMR/30% ABMR). All groups had ABMR and T-Cell mediated (TCMR) AR: NS 11% (76TCMR/6ABMR), DSA^– 15% (16TCMR/7ABMR) and DSA⁺ 43% (8TCMR/31ABMR), p<0.0001. ABMR more frequent in pre-Tx DSA⁺ pts, p<0.0001 and was associated with previous Tx (OR 15, p<0.0001), BT (OR 2.718, p=0.01), female (OR 3.63, p<0.001) and >5 mismatches (OR 2.32, p=0.025) and pre-Tx DSA⁺ (OR 9.41;p<0.0001). DSA-MFI was similar between AR⁺and AR^–pts, 4419±3690 vs 3670±2707, p=NS. DSA⁺/AR⁺pts had worse GS when compared to DSA⁺/AR^–and DSA^–and NS with or withou AR

(Fig1). PS was similar in all groups.

Conclusion: Pre-Tx DSA was a risk factor for AR, however DSA level was not a predictor for ABMR. AR occurrence in DSA⁺ pts strongly impacted on long-term graft survival when compared to DSA⁺pts without AR, highlighting the impact of acute rejection on graft survival.

CITATION INFORMATION: Souza P, Aguirre A, Bezerra G, Rodrigues H, Agena F, David D, de Paula F, David-Neto E, Castro M. Graft Survival in Sensitized and Non-Sensitized Patients: Role of the Combination of Donor-Specific Antibodies and Acute Rejection. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Souza P, Aguirre A, Bezerra G, Rodrigues H, Agena F, David D, Paula Fde, David-Neto E, Castro M. Graft Survival in Sensitized and Non-Sensitized Patients: Role of the Combination of Donor-Specific Antibodies and Acute Rejection. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/graft-survival-in-sensitized-and-non-sensitized-patients-role-of-the-combination-of-donor-specific-antibodies-and-acute-rejection/. Accessed May 9, 2025.

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