Sub-Clinical Acute Rejection (subAR) Detected by Both Surveillance Biopsy (SBx) and a Peripheral Blood Molecular Biomarker Correlates with De Novo Donor Specific Antibody (dnDSA) Following Kidney Transplant (KT)
1Mayo Clinic, Phoenix
2Northwestern University, Chicago
3Rho Federal Systems, Chapel Hill
4National Institute of Allergy and Infectious Disease, Bethesda
5Scripps Health, La Jolla
6Cleveland Clinic, Cleveland
7Medical University of South Carolina, Charleston.
Meeting: 2018 American Transplant Congress
Abstract number: C31
Keywords: Alloantibodies, Genomic markers, Kidney transplantation, Protocol biopsy
Session Information
Session Name: Poster Session C: Kidney Chronic Antibody Mediated Rejection
Session Type: Poster Session
Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
AIM
We investigated the correlation between subAR diagnosed by SBx or by a newly-defined biomarker, and the development of dnDSA.
METHODS
307 KT patients enrolled into a multi-center 24-month observational study underwent SBx at 2-6, 12 and 24 months. Precise clinical phenotypes (PCP) were used to define subAR: Banff > borderline changes and/or antibody mediated rejection. The control group consisted of patients with Banff i=0 and t=0, g=0, ptc=0; ci=0 or 1 and ct=0 or 1. All patients had stable renal function: serum Cr <2.3 mg/dl and <20% increase in Cr compared to lowest of 2-3 prior values. Peripheral blood paired with SBx was used to generate a gene expression profile (GEP) predictive of subAR. Based on serial assessments, patients were assigned to 3 groups: subAR only (Group 1), >1 instance of subAR (Group 2), and no subAR (Group 3) based on either the PCP or GEP.
RESULTS
Based on the PCP 12%, 51%, and 37%, or GEP, 11%, 41%, and 48% KT recipients were included in Groups 1, 2 and 3 respectively. The prevalence of dnDSA was measured in each group:
| PCP | GEP | |||||
| Group | 1 | 2 | 3 | 1 | 2 | 3 |
| % Class I | 18.2 | 8.4 | 4.1 | 18.8 | 7.8 | 4.5 |
| % Class II | 21.2 | 19.6 | 5.5 | 18.8 | 17.2 | 6.7 |
For the PCP, there was a significant difference between Groups 1 and 3 in the development of class I and class II dnDSA (p=0.01), and of class II dnDSA (p<0.01) between Groups 2 and 3. For the GEP, there was also a significant difference between Groups 1 and 3 for class I (p=0.01) and class II (p=0.04), and in class II between Groups 2 and 3 (p=0.01). No differences were noted in non-specific HLA antibodies.
CONCLUSIONS
The presence of subAR, diagnosed by SBx or a newly-defined molecular biomarker in peripheral blood, was strongly associated with the development of dnDSA following KT in a 24-month observational study.
CITATION INFORMATION: Heilman R., Friedewald J., Kurian K., Whisemant T., Poggio E., Marsh C., Baliga P., Bridges N., Odim J., Brown M., Ikle D., Armstrong B., Zhao L., Salomon D., Abecassis M. Sub-Clinical Acute Rejection (subAR) Detected by Both Surveillance Biopsy (SBx) and a Peripheral Blood Molecular Biomarker Correlates with De Novo Donor Specific Antibody (dnDSA) Following Kidney Transplant (KT) Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Heilman R, Friedewald J, Kurian K, Whisemant T, Poggio E, Marsh C, Baliga P, Bridges N, Odim J, Brown M, Ikle D, Armstrong B, Zhao L, Salomon D, Abecassis M. Sub-Clinical Acute Rejection (subAR) Detected by Both Surveillance Biopsy (SBx) and a Peripheral Blood Molecular Biomarker Correlates with De Novo Donor Specific Antibody (dnDSA) Following Kidney Transplant (KT) [abstract]. https://atcmeetingabstracts.com/abstract/sub-clinical-acute-rejection-subar-detected-by-both-surveillance-biopsy-sbx-and-a-peripheral-blood-molecular-biomarker-correlates-with-de-novo-donor-specific-antibody-dndsa-following-kidney-tran/. Accessed May 16, 2025.« Back to 2018 American Transplant Congress