Long-Term Outcomes of Eculizumab-Treated Positive Crossmatch Recipients: Allograft Survival, Histologic Findings, and Natural History of the Donor-Specific Antibodies
Mayo Clinic, Rochester, MN
Meeting: 2019 American Transplant Congress
Abstract number: 28
Keywords: Alloantibodies, Kidney transplantation, Rejection, Sensitization
Session Information
Session Name: Concurrent Session: Kidney Immunosuppression: Desensitization
Session Type: Concurrent Session
Date: Sunday, June 2, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 2:54pm-3:06pm
Location: Ballroom A
*Purpose: We aimed to determine long-term outcomes for eculizumab-treated, positive crossmatch (+XM) kidney transplant recipients as compared with +XM and age-matched negative crossmatch (−XM) control patients.
*Methods: We performed a retrospective observational study and examined allograft survival, histologic findings, long-term B-cell flow cytometric XM (BFXM), and factors associated with allograft loss.
*Results: The mean (SD) posttransplant follow-up was 6.3 (2.5) years in the eculizumab group; 7.6 (3.5), +XM control group; and 7.8 (2.7), in the −XM control group. Overall and death-censored allograft survival were similar in both +XM groups (P=.73, P=.48) but less than in −XM control patients (P<.001, P<.001). In the eculizumab group, 57.9% (11/19) of allografts had chronic antibody-mediated rejection, but death-censored allograft survival at 5 and 7 years was 76.6% and 75.4% respectively (Figure 1). Baseline immunoglobulin G3 (IgG3) positivity and BFXM ≥300 were associated with allograft loss. Additionally, donor-specific antibodies appeared to decrease in eculizumab-treated patients. After excluding patients who received posttransplant plasmapheresis, 42.3% (9/21) had negative BFXMs, and 31.8% (7/22) had completely negative single antigen beads 1 year after transplant.
*Conclusions: In conclusion, eculizumab-treated +XM patients had reduced allograft survival compared with −XM controls but similar survival to +XM controls. IgG3 and BFXM tests may be used for risk stratification in +XM transplantation.
To cite this abstract in AMA style:
Schinstock C, Bentall A, Byron S, Cornell L, Everly M, Gandhi M, Stegall M. Long-Term Outcomes of Eculizumab-Treated Positive Crossmatch Recipients: Allograft Survival, Histologic Findings, and Natural History of the Donor-Specific Antibodies [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-outcomes-of-eculizumab-treated-positive-crossmatch-recipients-allograft-survival-histologic-findings-and-natural-history-of-the-donor-specific-antibodies/. Accessed May 12, 2025.« Back to 2019 American Transplant Congress