Pre Transplant Donor Specific Antibodies and Clinical Outcomes in Kidney Transplant Recipient on Steroid Free Maintenance Immunosupression Regimen.
1Renal Transplant, Indiana University School of Medicine, Indianapolis, IN
2Internal Medicine, Baqai University Hospital, Karachi, Pakistan
Meeting: 2017 American Transplant Congress
Abstract number: D79
Keywords: Alloantibodies, Flowcytometry crossmatching, Immunosuppression, Rejection
Session Information
Session Name: Poster Session D: Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Type: Poster Session
Date: Tuesday, May 2, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: The clinical relevance of pre transplant donor specific antibodies has been reported in few clinical studies with respect to its effect on the risk of rejection and graft loss. Most of these studies were however done on patient receiving a steroid based maintenance immunosuppression regimen and often include only few patients with DSA at the time of final crossmatch.
Methods: A retrospective chart review of patients who received a kidney transplant between Jan 1, 2005 and June 31, 2015 with minimal one year follow up. Patients with history of positive crossmatch or multi organ transplant were excluded. Patients received anti- thymocyte antibodies with pulse steroid induction (Early five days withdraw) except zero mismatches who received basiliximab. Patients were placed on steroid free two drugs Immunosupression regimen. Donor specific antibodies were checked using single antigen beads (One Lambda Inc.)
Results: 1978 patient's kidney alone transplant were included over a 10.5 years' period. Mean follow up was 4.52 +/2.79 years. 101 patients (4.7%) had pre transplant DSA (DSA+) at time of transplant with negative flow cytometry crossmatch. One year episode or acute rejection was 29.7% vs 18.3%, p=0.0002 in DSA+ vs negative DSA (DSA-) respectively. Similar analysis comparing DSA+ with desensitization therapy and DSA+ without desensitization therapy was 29% vs 30 %, p=0.09. There were no significant differences in death censored graft survival patient survival between the DSA+ and DSA – groups. (p=0.13 and 0.27 respectively)
Conclusion: Pre-transplant donor specific antibodies are associated with higher risk of 1 year acute kidney allograft rejection with no significant impact on intermediate graft and patient survival in this cohort of patients receiving steroid free maintenance immunosuppression regimen. Pre tx DSA should therefore not be a barrier to kidney transplant especially when considering steroid free immunosuppression regimen.
CITATION INFORMATION: Adebiyi O, Sharfuddin A, Yaqub M, Hussain S, Mishler D, Sharfuddin A, Goggins W, Taber T. Pre Transplant Donor Specific Antibodies and Clinical Outcomes in Kidney Transplant Recipient on Steroid Free Maintenance Immunosupression Regimen. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Adebiyi O, Sharfuddin A, Yaqub M, Hussain S, Mishler D, Sharfuddin A, Goggins W, Taber T. Pre Transplant Donor Specific Antibodies and Clinical Outcomes in Kidney Transplant Recipient on Steroid Free Maintenance Immunosupression Regimen. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/pre-transplant-donor-specific-antibodies-and-clinical-outcomes-in-kidney-transplant-recipient-on-steroid-free-maintenance-immunosupression-regimen/. Accessed November 24, 2024.« Back to 2017 American Transplant Congress