Background: We aimed to investigate the importance of pre-transplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-HLA antibodies (DSA) and immune monitoring of these patients with Luminex single antigen beads and whole blood gene expression profiles.

Methods: Patients with DSA mean fluorescence intensity (MFI) values between 1,000-5,000 and flow-cytometry T and B cell cross-match channel shift values of 50-150 and 100-250, respectively were accepted for transplantation. Luminex assay was performed at 1, 3 and 12 months, BKV-PCR monthly up to 9 and 12 months post-txp. Whole blood gene expression profiles were studied by Affymetrix Human Gene 1.0 ST Array pre- and at 3 months post-txp. All patients with DSA received Thymo (total 6 gram) and IVIG (2 gram/kg).

Results: Between May 2009 and June 2012, 54 patients with pre-txp DSA and 268 without DSA received kidney transplantation. Patients had pre-txp mean number of 1.67 ± 0.83 DSAs and 2926 ±2904 of mean MFI values. The mean Flow-cytometry T and B cell cross-match channel shift was 136 ± 50 and 162 ± 60, respectively. Baseline demographic characteristics are shown in the Table. During a median follow-up of 37 months there were no significant differences between the 2 groups in terms of patient and graft survival, acute rejection rate, serum creatinine levels and development of BKV and CMV viremia. Total of 28 patients lost 44 DSA, and there was a significant decrease in post-transplant mean number of DSAs (0.69 ± 0.85) and mean MFI (1185 ± 2202) values of DSAs (p-values <0.001). The analysis of whole blood gene expression profiles comparing DSA+ and DSA- patients before and at 3 months post-txp is ongoing.

Conclusion: We demonstrate that similar patient and graft survival rates can be achieved in sensitized pre-txp DSA+ patients compared to DSA- patients with pre-txp immunologic risk assessment and immune monitoring.

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