Background. We have shown 70% of DSA+ patients lose all DSAs within 12 months and rarely have chronic rejection whereas the remaining 30% show DSA persistance and high rates of chronic rejection. We began preemptive desensitization in an attempt to promote DSA loss and reduce chronic rejection. We report the impact of desensitization on posttransplant DSA and 3 yr clinical outcome. Results are also compared to historically untreated cohorts.
Methods. Between 2006-10, cadaveric transplant recipients received points for PRA>50% (1), FCXM ≥100 (1) or ≥200 MCS (2), DGF (1) on POD 0. Patients with ≥3 points preemptively received IVIG/PP thrice/wkly for 2 wks. DSAs were monitored quarterly by luminex.
Results. Patients received no treatment (Nonsensitized, n=162) or IVIG/PP (n=29). DSA frequency was less in Nonsensitized vs. IVIG/PP (11 vs. 80%, p<0.01). Among IVIG/PP, DSAs were directed against Class I (50%) or both I/II (50%) with MFIs of 6641±4749 and 11280±6598, respectively. DSA resolved within 1 yr among 70% IVIG/PP (DSAloss) but persisted in 30% (DSAstay). DSA loss was equivalent (ns) whether anti-Class I or II. Graft survival and clinical metrics were equivalent (ns) between Nonsensitized and IVIG/PP DSAloss and IVIG/PP DSAstay.
|Chronic Rejection (%)||4||10||20|
|Failed due to Chronic Rejection (%)||3||0||0|
|Graft Survival (%)||97||95||80|
When compared to historically untreated cohorts, outcomes were equivalent(p=ns) between Nonsenitized and DSAloss groups (not shown). However, chronic rejection-free graft survival was markedly improved among IVIG/PP DSAstay versus historical untreated DSAstay.
|IVIG/PP DSAstay||Historic DSAstay|
|Chronic Rejection (%)||20**||43|
|Failed due to Chronic Rejection (%)||0**||27|
|Graft Survival (%)||80**||67|
Conclusions. Preemptive treatment among sensitized patients resulted in chronic rejection-free graft survival equivalent to nonsensitized patients and significantly better than historically untreated patients with DSA persistance. Unexpectedly, desensitization didn't increase DSA elimination and the mechanism responsible for clinical improvement is unclear.
To cite this abstract in AMA style:Kimball P, Sharma A, Behnke M, McDougan F, King A. Preemptive Desensitization among Sensitized Renal Recipients Improves Graft Survival Despite Posttransplant DSA Persistance [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/preemptive-desensitization-among-sensitized-renal-recipients-improves-graft-survival-despite-posttransplant-dsa-persistance/. Accessed October 27, 2020.
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