De novo donor-specific antibody (DSA) is associated with antibody-mediated rejection (ABMR) and allograft loss. The aim of our study was to examine the histology associated with subclinical de novo DSA and to identify predictive factors of subclinical ABMR.

Retrospective multicentric study (9 french kidney transplant units of the Spiesser Group). All patients with a de novo DSA (One Lambda, MFI > 1000) without graft dysfunction and biopsied for DSA apparition were included in the study. Clinical, biological and histological characteristics of the patients were studied.

107 patients (76M/31F; mean age: 49.3 +/- 12.7 years old) were biopsied 3.7 months (median) after the occurrence of a de novo DSA and after 65.3 months (median) after kidney transplantation. Graft function was stable during the 3 months before biopsy: MDRD = 57.3 +/- 18.7 mL/min/1.73 m[sup2]; proteinuria = 0.16 +/- 0.14 g/g. DSA was in a large part a class 2 DSA (class 2 alone: 70.3%). Biopsy led to the diagnosis of ABMR according to Banff score in 42 cases (39.2%) with peritubular C4d deposition in 15 cases (35.7%). Univariate analysis showed that the absence of steroids on the day of biopsy, presence of both class 1 and 2 DSA, the MFI of immunodominant DSA and the sum of the MFI of the DSA were associated with the diagnosis of subclinical ABMR. In multivariate analysis, only the sum of the MFI were still predictive (MFI > 7832: OR=5.92, 1.63-21.46, p=0.006).

Performing a kidney graft biopsy for the occurrence of de novo DSA without renal dysfunction lead to the diagnosis of a subclinical ABMR process in about 40%. This screening, guided by antibodies intensity, might allow the clinicians to initiate a specific tratement early before the organ dysfunction.

CITATION INFORMATION: Bertrand D., Jaureguy M., Garrouste C., Sayegh J., Bouvier N., Caillard S., Lanfranco L., Galinier A., François A., Hau F., Etienne I., Gatault P. Protocolar Biopsies in Patients with Subclinical De Novo DSA in Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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