Date: Saturday, May 30, 2020
Session Name: Biomarkers, Immune Assessment and Clinical Outcomes IV
Session Time: 3:15pm-4:45pm
Presentation Time: 3:27pm-3:39pm
*Purpose: Preformed donor specific antibody to HLA Class II (pDSA) is suggested to be an independent risk factor for mortality in simultaneous liver and kidney transplant (SLK). In a previous study the risk was attributed to patients with a sum mean fluorescence intensity (MFI) > 2000, leading to caution in selecting patients with pDSA for combined transplant. We sought to examine the effect of increasing levels of pDSA on patient survival and determine whether the risk increases in patients transplanted with high pDSA (sum MFI >5000).
*Methods: A single-center retrospective review of 77 recipients of SKT from 1/2008 to 9/2018 was performed. Groups were pDSA negative (nMFI), pDSA-weak (any MFI >3000, aMFI), and pDSA-strong (high MFI >5000, hMFI). Primary endpoints were 60-day rejection rates (RR), death-censored graft survival (GS) and patient survival (PS). Statistical analysis used chi square for demographics, Cox proportional hazards for multivariate analysis, and Kaplan-meier plots for survival.
*Results: 13 patients with Class II pDSA were identified (aMFI), of which nine were hMFI (MFI range 5793-100200). Of patients with pDSA, 8/13 (61.5%) had persistent DSA to 12 months after transplant. RR for kidneys trended toward being higher in the hMFI group (11.1% vs. 1.6% nMFI) but RR for liver were clinically similar (11.1% hMFI vs. 9.7% nMFI). Graft survival decreased with increased pDSA levels both for kidney (3-year GS 95.1% nMFI, 87.5% aMFI, 75.0% hMFI) and liver (91.5% nMFI, 80.8% aMFI, 66.7% hMFI) allografts. Patient survival was similar between nMFI and aMFI (Fig. 1). However, in patients with higher MFI, PS diverged at 2 years and univariate mortality was higher in the hMFI group (3-year PS 76.2% nMFI, 67.3% aMFI; 50.0% hMFI). Non-time-dependent mortality was noted in 3/8 (37.5%) of patients with persistent DSA and in 1/5 (20.0%) of patients without persistent DSA.
*Conclusions: Preformed Class II DSA may increase risk of death-censored kidney and liver GS and mortality but only in patients with strong levels of pDSA2. Persistent DSA may correlate with mortality, warranting post-transplant HLA antibody monitoring, and may represent an opportunity for aggressive immunologic intervention post-transplant.
To cite this abstract in AMA style:Fleetwood V, Papageorge C, Aufhauser D, Leverson G, Welch B, Hidalgo L, Foley D, Yankol Y, D'Alessandro A, Al-Adra D, Redfield R, Mezrich J. Preformed Donor Specific Antibody and Mfi-Dependent Effects in Simultaneous Liver-Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/preformed-donor-specific-antibody-and-mfi-dependent-effects-in-simultaneous-liver-kidney-transplantation/. Accessed September 29, 2020.
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