Introduction: Complement fixing donor specific antibodies (DSA) as detected by presence of C3d at the time of rejection is associated with poor graft outcome;no studies have explored the role pre-transplant; especially in Human leucocyte Antigen- Antibody incompatible transplants (HLA-AIT).Methods: Analysed 117 patient samples either complement dependent cytotoxicity (CDC) or Flow Crossmatch(FC) positive at pre-conditioning who underwent direct transplantation after desensitisation. C3d (Immucor) assay was performed and the results correlated with early antibody mediated rejection (EAMR) (within first 30 days) and death censored allograft survival (DCGF). Results: Of 117 cases, C3d positive DSAs were present in 49 (42%) cases and there was trend towards predication of EAMR, although statistical significance not reached (p 0.70).

C3d DSA correlated significantly with poor DCGF (p < 0.001) The five-year DCGF was 56 % in C3d positive group compared to 86% in negative group.

Discussion: Presence of pre-transplant C3d DSA strongly predicts renal allograft survival. Allograft survival in C3d negative patients is comparable to non-sensitised living donor transplants. This enables the differentiation of IgG antibodies of varying pathogenicity and the potential role of C3d as additional biomarker in pre-transplant workup. Mutivariate analysis is being performed and will be presented at the meeting.

CITATION INFORMATION: Babu A, Shaw O, Howe L, Kessaris N, Dorling A, Mamode N, Vaughan R, Krishnan N, Higgins R, MItchell D, Briggs D, Daga S. Presence of Complement Activating Donor Specific Antibodies Is Associated with Poor Renal Allograft Survival: Two Centre Retrospective Study. Am J Transplant. 2017;17 (suppl 3).

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