Background: Presence of anti-HLA donor specific antibodies (DSAs) has been associated with inferior kidney transplant outcomes. Identification of risk factors for de novo DSAs could help identify at risk patient population with opportunities for intervention to limit untoward consequences and outcomes.

Methods: All patients who underwent a kidney transplant at our institution from January 2012 to May 2015 were included in this analysis. DSA was monitored prospectively in all patients using a solid phase immunoassay platform.

Results: Two hundred fifty patients underwent 252 kidney transplants over this specified period. African Americans constituted 49.6%, male gender 56.8% and live donor transplants for 53.6% of patients in this group, with a mean age of 51.2 years. cPRA was positive in 34.3% patients and DSA was detectable in 5.2% of patients before transplant. T-cell and B-cell flow cytometric crossmatch was positive in 2.8% and 2.4% patients. Post-transplant DSA was determined in 228 patients for a total of 770 DSA studies. Of these, 22.1% patients had at least one DSA study, 23.8% two, 18.4% three and 26.5% had four or more DSA studies over time. De novo DSA was observed in 31 (13.7%) patients, with 19 (57.6%) having at least one HLA class I or class II antibody, 7 (21.2%) with two anti-HLA antibodies and 7 (21.2%) with three or more antibodies. Pre-transplant cPRA (OR=5.2, 95%CI=2.2-11.9, p<0.01), lack of compliance (OR=10, 95%CI=1.2-81.8, p=0.02), and acute cellular rejection (OR=3.8, 95%CI=1.5-9.5, p<0.01) were associated with a higher risk for development of de novo DSA. Patients with a de novo DSA had a higher serum creatinine concentration (p=0.02) and a significantly worse kidney allograft survival (HR=3.8, 95%CI=1.6-9.4, P<0.01).

Conclusions: Pre-transplant sensitization, suboptimal compliance, and acute rejection were independently associated with risk for de novo DSA development. Patients with de novo DSAs were more likely to suffer from low renal clearance and had inferior graft survival. Transplant recipients with the given risk subset should be monitored closely for de novo DSA to limit such untoward consequences on kidney allografts.

CITATION INFORMATION: Javaid B, Rosen-Bronson S, Li D, Awwad M, Gilbert A, Ghasemian S, Verbesey J, Abrams P, Grafals M, Fenton J, Cannon C, Rapisura J, Moore J, Cooper M. Risk Factors and Consequences of De Novo Anti-HLA Donor Specific Antibodies in Kidney Transplant Recipients: The Force Awakens. Am J Transplant. 2017;17 (suppl 3).

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