Introduction: Antibody mediated rejection (AMR) is one of the most difficult complications to treat in kidney transplantation. We previously reported on our experience with an aggressive regimen to avoid AMR through early screening and treatment of de novo donor specific antibody (DSA). Such aggressive treatment raises obvious concerns about increased infectious risk. In this study, we analyze the infectious burden resulting from DSA treatment.

Methods: We conducted a chart review on recipients of 614 kidney transplants since implementation of our new regimen for screening and treatment of DSA. We recorded infection severity based on the Severity Grading Table from the Blood and Marrow Transplant Clinical Trials Network. Infections occurring prior to development of DSA were censored. We then compared those patients who were treated for DSA with those who were not.

Results: There were 55 patients in the DSA treatment group and 48 patients in the DSA untreated group. The groups were found to be well matched for age at transplant, ethnic makeup, induction therapy, HIV risk, CMV risk, and donor type (table 1). There were no differences found in the infection severity (severity score per infection) or the total infectious burden (total severity per patient) between the groups (table 2).

Conclusion: An aggressive screening and treatment protocol for de novo DSA not only eliminated the development of AMR but did so without a significant increase in infectious risk.

CITATION INFORMATION: Murthy A., Karaballa A., Vranic G., Javaid B., Moore J., Yi S., Verbesey J., Abrams P., Ghasemian S., Cooper M., Gilbert A. Having Your Cake and Eating It Too: An Aggressive Protocol for DSA Treatment Does Not Doom Patients to High Infectious Risk Am J Transplant. 2017;17 (suppl 3).

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