Introduction: Pre-transplant IgG antibody screening is common due to its established role of predicting rejection and graft survival; the role of pre-formed IgM human leukocyte antigen (HLA) specific antibodies has not been thoroughly explored. We aimed to explore whether testing for pre-formed IgM HLA-specific donor-specific antibody (DSA) is useful for prediction of rejection and graft survival in a large cohort of patients undergoing HLA antibody incompatible transplantation.

Methods: Samples from 92 patients were tested at pre-conditioning or pre-transplant for cases that did not require antibody removal therapy using Luminex microbead assay with EDTA containing wash buffer (LAB screen SAB, One Lambda, CA, USA). IgM was defined positive if the MFI values were greater than 2000. Presence of pre-formed IgM DSA was correlated with early antibody mediated rejection (within day 30 post transplantation) episodes and graft failure. Statistical analyses were performed using SPSS IBM software (Fischer exact 2 tailed test and Kaplan Meier survival analysis).

Results: Early antibody medaited rejection (within 30 days) was seen in forty-seven out of the ninety-two cases, of which 17 were positive for IgM DSA. Statistical analysis by Fisher's Exact Test (two-tailed) at 5% significance level showed no significant association of episodes of early rejection with pre-formed IgM HLA-specific DSA, P = 0.83. Statistical analysis of death censored graft survival in all eighty-six cases showed no significant association with pre-formed IgM HLA-specific DSA, P=0.44.

Discussion: Additional testing for pre-formed IgM HLA DSA is not useful for prediction of rejection or graft survival in a cohort of HLA-incompatible kidney transplantation. This finding needs to be validated in multi-variate analysis accounting for other baseline characteristics and for larger cohort in a multi-centre study.

CITATION INFORMATION: Andreou A, Babu A, Barber T, Higgins R, Briggs D, Mitchell D, Khovanova N, Shaikhina T, Daga S. Role of Preformed IgM Donor Human Leucocyte Antigen (HLA) Specific Antibodies in HLA Incompatible Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).

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