Background: Development of de novo donor-specific antibodies (dnDSA) has detrimental effects on kidney graft survival. But, there is limited information about the relationship of dnDSA to pancreas graft survival.

Methods: We report our experience among pancreas transplant recipients with or without a kidney who were transplanted between 01/01/2005 and 08/31/2017 who had post-transplant DSA monitored. We compared outcomes between the dnDSA+ and dnDSA– groups. dnDSA was defined as any detection of DSA which was not present before transplant.

Results: We identified 541 pancreas transplant recipients during the study period, of which 121 (22%) developed dnDSA and 421 (78%) did not. Males and Caucasians were significantly more common in the dnDSA- group. Other baseline characteristics were similar between the groups. Mean post-transplant follow up was 4.6±3.6 years in the dnDSA+ and 5.1±3.7 years in the dnDSA- group. Mean interval from transplant to the detection of dnDSA was 2.1±3.1 years, ranging from 15 days to 11.4 years. 39 (32%) developed dnDSA against class I HLA antigen, 68(56%) developed against class II HLA antigen and 14(12%) developed against both class I and II. Out of 121 patients in the dnDSA+ group, 77 had persistent dnDSA on follow up, while in 43 dnDSA was transient and disappeared on last follow up and one did not have DSA rechecked. 63 (52%) of the patients in dnDSA+ and 100(24%) in dnDSA- group underwent pancreas biopsy at some point in time. In some cases enzyme elevation and rejection preceded or was simultaneous to dnDSA appearance, while in others dnDSA was observed without elevation of enzymes but nonetheless stimulated a biopsy. Rejection was found in 51 (42%) patients in the dnDSA+ group, the majority of whom underwent biopsy for increased enzymes not dnDSA, and 84(20%) in the dnDSA- group had rejection (p<0.001). There was a total of 44(36%) graft failures in the dnDSA+ group and 72 (17%) in the dnDSA- group(p<0.001), and a similar trend was seen in death-censored graft survival between the groups. Graft survival did not differ between patients with persistent dnDSA and those with transient dnDSA.

Conclusion: Our findings suggest that dnDSA in pancreas transplant recipients are associated with increased rates of rejection and graft failure. Timely detection of dnDSA through regular screening and early treatment of pancreas rejection may ultimately improve graft outcomes.

CITATION INFORMATION: Parajuli S., Alagusundaramoorthy S., Aziz F., Garg N., Redfield R., Sollinger H., Kaufman D., Djamali A., Odorico J., Mandelbrot D. Outcomes of De Novo Donor Specific Antibodies in Pancreas Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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