There is limited information about the role of protocol kidney biopsies for de-novo donor specific antibodies (dnDSA) in kidney transplant recipients (KTR). We initiated monitoring of DSA per consensus conference recommendations during the first year post transplant and then annually, and performed a surveillance biopsy for dnDSA. There were 47 kidney transplant recipients with dnDSA between 01/1/2014 and 06/30/2016. Median age at time of transplant was 48±12 years, 68% were male. The most common causes of end stage renal disease were diabetes and glomerulonephritis. 38% were living kidney recipients and 17% were re-transplants. More than 60% received basilixmab for the induction. 42 patients underwent biopsy within 60 days of development of dnDSA while 5 did not. On biopsy, 26 (63%) had rejection and 16 (37%) did not. There were no significant differences in baseline demographics between rejection and no-rejection groups. Comparing no rejection vs rejection groups, 56% vs 12% had class I dnDSA (p=0.002), 31% vs 46% (p=0.35) had class II and 13% vs 42% (p=0.04) had both class I & II dnDSA. There were no significant differences in mean florescent intensity (MFIsum) between the two groups. Median post-transplant follow-up was 795 days in the no-rejection group and 921 days in the rejection group. Of those with rejection, 35% had cellular rejection (ACR), 35% had antibody-mediated rejection (AMR) and 30% had mixed rejection.Of the 42 patients who underwent biopsy, 22 had serum creatinine (Scr) and urine protein level at their baseline. Out of those 22 patients, 10 (45%) had sub clinical rejection. There was one graft loss in the no-rejection group and three in rejection group (p=0.83). Our findings demonstrate the utility of protocol biopsies in KTR with dnDSA. We found a high rate of rejection (62%) and clinically silent rejection (45%). In addition, biopsy findings were relatively evenly divided between ACR, AMR and mixed rejection, which require different treatments.

CITATION INFORMATION: Parajuli S, Reville P, Ellis T, Djamali A, Mandelbrot D. Outcomes of Protocol Allograft Kidney Biopsy in DeNovo Donor Specific Antibodies. Am J Transplant. 2017;17 (suppl 3).

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