Background: Donor-specific HLA antibody (DSA) formation in post-renal transplant patients is associated with chronic rejection and graft failure. IgG3 DSA has been associated with poorer graft survival. Previous studies in our transplant population have shown a > 20% risk of graft loss by 3 years after DSA formation. Detection of DSA occurs months before graft dysfunction, affording providers time to intervene. This study assessed whether the escalation of Mycophenolic acid (MPA) could reduce DSA and stabilize renal function in DSA positive patients and also the impact of IgG3 DSA.
Methods: 32 DSA positive patients were enrolled, 30 were followed for one year. MPA dose was escalated to a minimum daily dose of 1440 mg or the equivalent, with the maximum dose never exceeding the manufacturers recommendations. Serum was collected at enrollment and during routine clinic visits for DSA and IgG3 testing. HLA single antigen beads were analyzed by Luminex to determine donor specificity and strength of the antibodies, measured as mean fluorescence intensity (MFI). Immunosuppression consisted of a thymoglobulin induction, calcineurin inhibitor, Prednisone, and MPA.
Results: At 12 months daily MPA was > 1440 mg in 93% of patients. Transplant to DSA detection ranged from 1 month to 8 years with an average of 3 years. DSA detection to dose escalation ranged from 1 month to 10 years averaging 26 months. 20% were found to be IgG3 positive. Average time from DSA detection to intervention was 23 months for IgG3 negative patients compared to 37 months for positive. Participants maintained stable renal function.
Conclusions: Escalation of MPA can be beneficial for DSA positive patients to maintain stable renal function and DSA strength. Of note, there was an increased time between DSA detection and treatment for IgG3 positive patients. Longer follow-up is necessary to determine the role of IgG3 DSA. Further studies are warranted to determine if escalation of MPA will impact long term graft survival.
Bolin, P.: Grant/Research Support, Novartis, Speaker’s Bureau, Novartis. Parker, K.: Speaker’s Bureau, Novartis.
To cite this abstract in AMA style:Rebellato L, Bolin P, Parker K, Allsbrook A, Brown B, Kendrick S, Everly M, Terasaki P, Harland R. Renal Transplant Recipients with Positive Donor Specific Antibodies Maintain Stable Graft Function with Mycophenolic Acid Escalation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/renal-transplant-recipients-with-positive-donor-specific-antibodies-maintain-stable-graft-function-with-mycophenolic-acid-escalation/. Accessed April 18, 2021.
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