Pre-emptive Ivig For Dsa Positive Living Donor Kidney Transplant Recipients

B. Abdalla¹, D. Kellner², A. Diaz², Y. Zheng³, E. Reed⁴, Q. J. Zhang⁴

¹Medicine, Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, ²David Geffen School of Medicine at UCLA, Los Angeles, CA, ³UCLA Immunogenetics Center, Los Angeles, CA, ⁴Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA

Meeting: 2019 American Transplant Congress

Abstract number: D102

Keywords: Antibodies, Graft survival, HLA antibodies, IVIG

Session Information

Session Name: Poster Session D: Kidney Acute Antibody Mediated Rejection

Session Type: Poster Session

Date: Tuesday, June 4, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Intravenous immunoglobulin (IVIG) is used in desensitization regimens to modulate anti-human leukocyte antigen (HLA) donor-specific antibody (DSA) to facilitate transplantation of sensitized patients, however, the risk of acute antibody-mediated rejection (AMR) post IVIG therapy remains unclear. The aim of the study is to evaluate the impact of pre-transplant high dose IVIG on the incidence of acute rejection and long-term graft survival in patients transplanted with preformed HLA DSA.

*Methods: We retrospectively evaluated 676 adult living donor kidney transplant (LDKT) recipients transplanted at our institution between 2005-2013 with median follow-up of 5 years. HLA antibodies were measured using a solid phase single antigen Luminex assay with antibody strength represented as median fluorescence intensity (MFI) and T/B cell crossmatches were performed by CDC and flow cytometry. Most recipients with preformed DSA (DSA+) received high dose IVIG (2g/kg) at the time of transplant. Allograft biopsies were performed for cause only and interpreted independently by three renal pathologists. Acute cellular rejection (ACR) and AMR were diagnosed based on BANFF criteria. Statistical analysis was performed using STATA 14.2.

*Results: Out of 676 LDKT, 83 (12%) had preformed HLA DSA to either Class I or Class II HLA molecules (DSA+) < 6000 MFI. Of the 83 (DSA +) patients, 71 (86%) received high dose IVIG while 12 did not. ACR and/or AMR occurred in 20% (121/593) of patients without preformed DSA (DSA-), 92 % (11/12) in patients with preformed DSA but without pre-transplant IVIG (DSA+/IVIG-) and 35% (25/71) in patients with pre-formed DSA treated with IVIG (DSA+/IVIG+, p < 0.01). The incidence of ACR alone was not statistically different between the 3 groups. The frequency of AMR alone was 1% in DSA-group, 42% in DSA+/IVIG- group and 13% in DSA+/IVIG+ group (p < .01). Death-censored graft failure was 8% for (DSA-/IVIG-), 17% for (DSA+/IVIG-) and 21% for (DSA+/IVIG+) within the follow-up time. There was a significant difference in graft failure in DSA-/IVIG- group compared to DSA+/IVIG+ group (p> 0.01). No significant differences were found between the DSA+/IVIG- with either DSA+/IVIG+ or DSA- group.

*Conclusions: The incidence of AMR was higher in DSA+/IVIG+ group than DSA- patients. However, pre-emptive treatment of recipients with preformed DSA with IVIG at time of LDKT significantly reduced the incidence of AMR. Graft failure was significantly higher in DSA+ patients than DSA- patients. The small number of patients in (DSA+/IVIG-) group limited power to detect a difference in graft survival with pre-transplant IVIG treatment. This data supports the pre-emptive use of IVIG therapy at the time of transplant to reduce AMR in LDKT.

To cite this abstract in AMA style:

Abdalla B, Kellner D, Diaz A, Zheng Y, Reed E, Zhang QJ. Pre-emptive Ivig For Dsa Positive Living Donor Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/pre-emptive-ivig-for-dsa-positive-living-donor-kidney-transplant-recipients/. Accessed November 21, 2024.

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