Background: DSA have been associated to lower graft survival and a higher humoral rejection rate, but there is a concern about the clinical impact of pre-transplant DSA detected with Luminex and negative Flow-Crossmatch. The aim of this study is to compare acute rejection rate, graft survival, and patient survival in patient with DSA plus negative Flow-Crossmatch and those without DSA.

Methods: Prospective cohort study. From Jan/2004 to sep/2014 a total of 486 kidney transplant were performed. We compare those with pre-transplant DSA plus negative Flow-Crossmatch with those without DSA. The main outcome were acute rejection rate, humoral acute rejection rate, time to first rejection, graft and patient survival. Chi square test, Kaplan-Meier analysis and Log-Rank test were used.

Results: Only 397 patients with DSA determination were included for this analysis. Fifty six patients (14.10%) had pre-transplant DSA. Those patients with DSA had a higher risk for acute rejection (OR=2.4, p=0.015) and humoral rejection (OR=4.85, p<0.001), see figure A & B. Twenty five (6.30%) patients lost the kidney graft, and 12 (3.02%) patients died. There was not difference between both groups (with and w/o DSA) for graft survival and patients survival (Figure C,D).

Conclusions: Pre-transplant DSA with Negative Flow-Crossmatch, increased the risk for acute rejection and humoral rejection, but it was not associated with lower graft survival or lower patient survival.

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