Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
We sought to compare the long-term outcome of renal allograft recipients with de novo DSA (dnDSA) in the setting of stable allograft function versus dnDSA associated with an acute rejection (ACR).
Methods: A retrospective single-center review of 259 consecutive renal allograft recipients transplanted between January 2008 and December 2009. DnDSA screening was performed at 3,6,9,12 and every 6 months thereafter. DnDSA were defined as HLA-A, B, Cw, DR, DQ, or DP antibodies directed against the donor that were not present pre-transplant. All dnDSA had a median florescence index of greater than or equal to 2000 and were confirmed by repeated testing. Measurement of C1q binding was not performed. Twenty-eight recipients were excluded because of pre-transplant DSA (n= 24), or initial non-function (n=4).
Results: The study cohort included 231 recipients, with 60% male, mean age 50±12 years, 87% primary transplants, and 38% living donors. Median graft survival was 76 (range 3-133) months. There were 185 recipients with no dnDSA (Group 1), 31 recipients with dnDSA and stable function (Group 2), and 15 recipients with dnDSA associated with ACR (Group 3). Median time to first dnDSA was 16 (3-96) months. Death-censured graft survival was compared between groups as shown below.
The estimated 72 months survivals of Groups 1, 2, and 3 were 93%, 76%, and 26% respectively. In Group 3, the median time to first ACR was 9 (1-67) months post-transplantation, 7/15 (47%) occurred beyond one-year, and 13/15 (87%) were antibody-mediated.
Conclusion: In this cohort, development of dnDSA in recipients with stable graft function resulted in good but inferior long-term graft survivals compared to that of recipients with no DSA. In contrast, dnDSA associated with an acute rejection generally resulted in graft loss.
CITATION INFORMATION: Knight R., Nguyen D., Graviss E., Eagar T., Kuten S., Patel S., Moore L., Gaber A. Long Term Outcomes of Renal Allografts with De Novo DSA in the Setting of Stable Graft Function versus Acute Rejection Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Knight R, Nguyen D, Graviss E, Eagar T, Kuten S, Patel S, Moore L, Gaber A. Long Term Outcomes of Renal Allografts with De Novo DSA in the Setting of Stable Graft Function versus Acute Rejection [abstract]. https://atcmeetingabstracts.com/abstract/long-term-outcomes-of-renal-allografts-with-de-novo-dsa-in-the-setting-of-stable-graft-function-versus-acute-rejection/. Accessed December 12, 2019.
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