Introduction. HLA class II donor-specific antibodies (DSA's) have been associated with transplant glomerulopathy and ultimate graft loss. Despite these data, it is unclear if all class II DSA's should be entered as unacceptable in UNet or if there is a certain level that may be acceptable for transplantation without risking increased graft failure. We prospectively evaluated the effect of different levels of pre-transplant class II DSA's on short term graft outcome.

Materials and Methods. Fifty consecutive patients who were transplanted from May, 2010 to June, 2012 with HLA class II antibody were evaluated. All patients undergoing transplantation during that period were screened for HLA class II antibodies by a mix or PRA luminex antibody assay. If a patient had evidence of class II antibody by these methods, class II SAB was performed. The sample used for SAB analysis was from the date closest to deceased donor transplantation. The transplanted patients were divided into those with low (<25,000 SFI, standard fluorescence intensity) or high (SFI > 25,000 SFI) levels of class II DSA avidity. Class II DSA avidity was defined as the sum of each DSA a patient had.

Results. The data in Table 1 show that the incidence of humoral but not cellular rejection was significantly greater in the high class II DSA group than the low group. No hyperacute rejection occurred. Two grafts were lost in the high group, one to cellular rejection and one to technical/perfusion issues. The class II cPRA level and number of DR mismatches was greater in the high DSA group. Most of the class II antibodies were not C1q-fixing.

Conclusion. These data show that most of these adult patients (46% were ≥ 55) were successfully transplanted with good early (1-2years) graft outcome and remained rejection free despite the presence of high levels of class II DSA and DR mismatching.

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