Researchers have long categorized DSA into 2 types: preformed and de novo. However, there have been no studies that directly compare the 2 entities. Herein, we compare and contrast de novo DSA versus preformed DSA in a negative crossmatch primary renal transplant population.

Methods: 216 renal transplants were performed consecutively between 1999 and 2006 at East Carolina University and were not lost to follow-up. These patients were tested for antibodies by single antigen beads pre-transplant and sequentially post-transplant at 1, 3, 6, 9, 12 months and annually, thereafter. All patients were transplanted only if they had a negative crossmatch (CDC for deceased and Flow for living donors). All patients lost-to-follow-up were excluded from analyses.

Results: Of the 216 transplant patients, 47 were found to have de novo and 16 preformed DSA. In comparing acute rejection rates, preformed DSA and de novo DSA patients had nearly identical rates of AMR and ACR (Table). Beyond acute rejection, allograft survival also did not differ significantly between preformed and de novo DSA when assessing all patients from time of DSA appearance (Figure). Within 5 year 29% of preformed patients and 24% percent of de novo DSA patients failed, respectively (p=NS).

Conclusion: In all, we suggest that the terms “preformed” and “de novo” are not meaningful DSA categorizations in a primary crossmatch negative renal transplant patient given that short term risk and long term outcomes are the same when assessing patients from the time of DSA appearance. However, class I antibodies may be more likely in the patients entering transplant with DSA. Based on these finding, trials can be designed to use any DSA positive patient independent of when the DSA appears and possibly stratify based on class of DSA.

Everly, M.: Employee, One Lambda. Terasaki, P.: Stockholder, One Lambda.

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