Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Patients with high levels of preformed donor-specific antibodies (DSA) are often not considered for kidney transplantation (KT), despite negative CDC-crossmatch, mainly in regions where flow cytometry is not available. This study evaluated the 1-year outcomes of patients with preformed DSA receiving deceased donor (DD) kidneys according to two prophylactic strategies.
*Methods: Single-center retrospective cohort including DD KT recipients with preformed DSA (anti-HLA A, B or DR) >1,500 MFI and negative CDC-crossmatch transplanted between Jan/13 and Apr/17 (n=74). All patients received anti-thymocyte globulin 6mg/kg + tacrolimus + steroids + mycophenolate or mTOR inhibitor. Patients with DSA 1,500-3,000 MFI additionally received IVIG 2g/Kg (IVIG group, n=22). Those with DSA > 3,000 MFI received additional treatment with plasmapheresis (4 sessions) and IVIG 2g/Kg (PF group, n=54).
*Results: Patients were predominantly women (66%), 41±16 years-old, retransplantation in 45%, median Class I/II PRA = 70 (IQR 68) / 25 (IQR 68)%, respectively, and 55 (IQR 59) months on dialysis. 77% received kidneys from standard criteria donors. The main evaluated outcomes are demonstrated in Table 1.
*Conclusions: Despite the high incidence of acute rejection episodes, the tailored additional treatment with IVIG ± PF based on perceived immunological risk was associated with excellent transplant outcomes, suggesting this approach as an option for patients with preformed DSA.
|IVIG group||PF group|
|CMV infection or disease||9 (41)||10 (19)|
|BKV viremia or nephropathy||1 (5)||8 (15)|
|Infection requiring hospital readmission||7 (32)||25 (48)|
|AMR or mixed rejection (AMR + cellular)||3 (14)||11 (21)|
|Death-censored graft survival at 1 year (%)||91||89|
|Patient survival at 1 year (%)||100||96|
|eGFR at 1 year (ml/min)||65±39||55±36|
To cite this abstract in AMA style:Sandes-Freitas TV, Neri B, Junior JJunqueira, Leite T, Sales M, Esmeraldo R. Posttransplant Prophylactic Therapy with IVIG/Plasmapheresis in Kidney Transplant Recipients with Preformed Donor-Specific Antibodies [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/posttransplant-prophylactic-therapy-with-ivig-plasmapheresis-in-kidney-transplant-recipients-with-preformed-donor-specific-antibodies/. Accessed October 30, 2020.
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