Successful Kidney Transplantation of Highly Sensitized Candidates across Positive Cross Match and Strong Donor-Specific HLA-DP Antibodies without Desensitization

R. Rajalingam¹, D. D. Gae², Z. G. Laszik³, M. M. Tavakol⁴, A. B. Webber⁵, K. Cunniffe², G. da Gente², R. Hirose⁴, G. Roll⁴, C. E. Freise⁴, J. P. Roberts⁴

¹Immunogenetics and Transplantation Laboratory (ITL), San Francisco, CA, ²Department of Surgery, Immunogenetics and Transplantation Laboratory (ITL), San Francisco, CA, ³Department of Pathology, University of California San Francisco, San Francisco, CA, ⁴Department of Surgery, University of California San Francisco, San Francisco, CA, ⁵Department of Medicine, University of California San Francisco, San Francisco, CA

Meeting: 2019 American Transplant Congress

Abstract number: 160

Keywords: Antibodies, HLA antibodies, HLA matching, Kidney transplantation

Session Information

Session Name: Concurrent Session: Histocompatibility and Immunogenetics

Session Type: Concurrent Session

Date: Sunday, June 2, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 4:42pm-4:54pm

Location: Room 309

*Purpose: Over 50% of kidney transplant (Ktx) candidates with 100% CPRA display HLA-DP antibodies, which impair the chances of finding a compatible deceased donor (DD) despite national sharing. Herein, we assessed the impact of donor-specific HLA-DP antibodies (DP-DSA) on Ktx outcome.

*Methods: DD Ktxs performed at UCSF (n=569) from 2013-16 were analyzed. Based on pre-tx DSA status, recipients were divided into 3 groups: DSA -ve (n=465), non-DP DSA +ve (n=81), and DP-DSA +ve (n=23). All recipients received standard immunosuppression, and DP-DSA +ve recipients received additional 1 dose IVIG at day-1 post-tx. Grafts were evaluated by 6 mo protocol biopsies (Bx) and cause Bx. HLA antibodies were tested using single antigen bead assay (One Lambda).

*Results: There were more highly sensitized patients (CPRA>97%) and well-matched Ktx in DP-DSA +ve group compared to the other 2 groups (Table). All recipients in DSA -ve and non-DP DSA +ve groups had a -ve T and B cell pronase flow-crossmatch (FXM), while 30% (n=7) of DP-DSA +ve group that had a DP-DSA of >10,000 MFI, displayed a +ve B-FXM (MCS~200; 120 cutoff). There were no hyper acute rejection episodes in all 3 groups. The DP-DSAs were self-decayed overtime post-tx in all 23 recipients transplanted with pre-formed DP-DSAs (Figure). The Bx findings revealed no significant difference in the rate of antibody-mediated rejection (ABMR) or in acute cellular rejection (ACR) between the 3 groups. Two recipients transplanted with DP-DSAs but -ve XMs lost their grafts: one was a 46F re-tx recipient with 100% CPRA, 1/12 HLA-mismatch, DP4 DSA (MFI=6956), lost due to ACR in 4 months; another was 62M, 19% CPRA, 7/12 HLA-mismatch, DP1 DSA (MFI=4165), suffered Polyomavirus nephropathy at 5 months.

*Conclusions: Kidneys can be transplanted across DP-DSAs with no apparent effect on graft survival. This strategy increases the DD Ktx in highly sensitized patients without pre-tx desensitization. The long-term outcome studies are ongoing.

To cite this abstract in AMA style:

Rajalingam R, Gae DD, Laszik ZG, Tavakol MM, Webber AB, Cunniffe K, Gente Gda, Hirose R, Roll G, Freise CE, Roberts JP. Successful Kidney Transplantation of Highly Sensitized Candidates across Positive Cross Match and Strong Donor-Specific HLA-DP Antibodies without Desensitization [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/successful-kidney-transplantation-of-highly-sensitized-candidates-across-positive-cross-match-and-strong-donor-specific-hla-dp-antibodies-without-desensitization/. Accessed November 22, 2024.

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