Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: Kidney transplantation is associated with improved survival and quality of life relative to dialysis for patients with end-stage renal disease (ESRD). Patients who are highly human leukocyte antigen (HLA)-sensitized are among the most vulnerable populations awaiting kidney transplantation. The recent UNOS organ allocation policy change has enhanced access to transplantation for patients who are highly sensitized. At our institution, we have implemented guidelines for the management of donor specific antibody (DSA) positive patients which includes plasmapheresis, thymoglobulin, and rituximab induction. The purpose of this study was to assess our DSA protocol on sensitized patient outcomes.
Methods: This was a single center, retrospective data review of 150 patients who underwent kidney transplantation at our center between January 2014 and June 2016.
Results: Of the kidney transplants performed, 34.7% (52/150) received the DSA protocol. Of patients receiving the DSA protocol, 5 were virtual crossmatch (XM) and 3 flow B cell XM positive. All were flow T cell XM and cytotoxic XM negative. Recipients averaged a class I PRA of 51% and 36% for class II. Donor specific anti-HLA antibodies had an average class I MFI of 2773 and class II MFI of 4417. Overall, 16.7% (25/150) of recipients had biopsy proven rejection. Of the recipients who received the DSA protocol, 15.4% had biopsy proven rejection with the majority (62.5%) diagnosed with acute cellular rejection (ACR), 25% of recipients had a combined ACR and antibody mediated rejection (AMR), and 12.5% had AMR alone. Stable serum creatinine (SCr) was observed in both the DSA positive group with a median SCr at 6 months 1.52 (IQR 1.25-1.83) and 1 year 2.21 (IQR 1.35-2.79) and DSA negative group with a median SCr at 6 months 1.57 (IQR 1.12-1.91) and 1 year 1.59 (IQR 1.36-1.96). Of the 5 patients that suffered graft loss, 1 was in the DSA positive group and also experienced one documented episode of ACR.
Conclusion: These data suggest induction with plasmapheresis, thymoglobulin and rituximab leads to superior outcomes in sensitized patients with low level anti-HLA antibodies. Based on our induction protocol and maintenance immunosuppression strategy, having low level anti-HLA antibodies should not be a contraindication to transplant.
CITATION INFORMATION: Lessmann E, Moaddab M, Manson M, Ram A, Kerman R, Jindra P. Renal Transplant Patient Outcomes Following Plasmapheresis, Thymoglobulin, and Rituximab Induction for High Risk DSA Positive Recipients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Lessmann E, Moaddab M, Manson M, Ram A, Kerman R, Jindra P. Renal Transplant Patient Outcomes Following Plasmapheresis, Thymoglobulin, and Rituximab Induction for High Risk DSA Positive Recipients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-transplant-patient-outcomes-following-plasmapheresis-thymoglobulin-and-rituximab-induction-for-high-risk-dsa-positive-recipients/. Accessed February 17, 2020.
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