Background: Evidence indicates that pre-transplant donor specific antibody (DSA) in kidney transplantation recipients worsens graft survival significantly. The impact of pre-transplant DSA on pancreas transplant outcome in patients with negative T-cell cytotoxicity cross-matches remains unclear.
Methods: We performed a retrospective analysis of 69 consecutive pancreas transplants (40 kidney-pancreas, 29 pancreas after kidney) performed at a single institution from Jan 2010 to May 2012. The presence of DSA before transplantation was detected by Luminex single-antigen assays. All recipients received prednisone/tacrolimus/mycophenlate mofetilbased immunosuppression. Recipients with DSA also received IVIG (1g/Kg preoperatively).
Results: Pre-transplant DSA was detected in 20 (29%) recipients. Demographics of the No-DSA and DSA groups were similar with respect to male sex (70% vs. 90%), recipient age (43+9 vs. 42+9 yrs., p=0.7), donor age (26+10 vs. 25+10 yrs., p=0.6), donor weight (74.5+21.2 vs. 75.7+29.9 kg, p=0.86), pancreas cold ischemic Time (CIT) (9h17m+2h10m vs. 10h6m+2h6m, p=0.2), kidney CIT (7h32m+2h vs. 9h33m+4h6m, p=0.07), pancreas warm ischemic time (WIT) (30.5+7 vs. 34.4+12 m, p=0.12), kidney WIT (31.5+7 vs. 32.3+6.5 m, p=0.9). Rejection occurred in 8 (16%) and 5 (25%) patients in the No-DSA and DSA groups (p=0.5). The median (range) time of first rejection was similar in both groups (No-DSA, 27 days (11-224); DSA, 33 days (25-124) p=0.9). Severe rejection (Banff 2a,b) occurred in 2 patients in the No-DSA group and 1 in the DSA group (p=0.68). Two pancreas grafts were lost from acute rejection in the NO-DSA group, both from non-compliance. The other causes of graft loss in the No-DSA group were duodenal leak (3), pancreatitis (3), thrombosis (1) and death (1); causes in the DSA group were leak, pancreatitis, thrombosis, and death (1 of each). Pancreas graft survival was comparable in the No-DSA and DSA groups at 3, 6, and 12 mo (92% vs. 100%, 85% vs. 94%, and 83% vs. 94% respectively). Kidney graft survival at 12 mo in the No-DSA and DSA groups was also similar at 96% vs. 92%.
Conclusion: The presence of pre-transplant DSA is not associated with reduced survival of pancreas allografts during short-term follow-up. Further studies are needed to clarify the effect of IVIG therapy and impact of DSA on long-term graft survival.
To cite this abstract in AMA style:Boehnert M, Selzner M, Marquez M, Bazerbachi F, Norgate A, McGilvray I, Schiff J, Cattral M. Presence of Pre-Transplant Donor Specific Antibody (DSA) Does Not Reduce Pancreas Allograft Survival in Recipients Treated with IVIG [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/presence-of-pre-transplant-donor-specific-antibody-dsa-does-not-reduce-pancreas-allograft-survival-in-recipients-treated-with-ivig/. Accessed October 30, 2020.
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