Tacrolimus Appears to Be a Protective Factor for De Novo DSA Formation in Non-Sensitized Kidney Transplant Patients.
1Department of Nephrology, Dialysis and Transplantation, Hôpital Lapeyronie, Montpellier, France
2Departement of Immunology, Hôpital Saint Eloi, Montpellier, France
3Inserm U1183,, IRMB,Hôpital Saint Eloi, Montpellier, France
Meeting: 2017 American Transplant Congress
Abstract number: 10
Keywords: Alloantibodies, Calcineurin, Kidney transplantation, Rejection
Session Information
Session Name: Concurrent Session: Assessing Risk for Antibody-Mediated Rejection in Kidney Transplant Recipients
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: E354a
Background.Development of de novo donor specific antibodies (dnDSA) concerns about 10% of patients within the first year following kidney transplantation and reach about 20% within 5 years. DnDSA are associated with antibody-mediated rejection (AMR) and graft failure. Few data are available regarding to predictive factors for dnDSA generation. We analysed a large cohort of unsensitized patients in order to evaluate dnDSA development and associated risk factors.
Methods. Patients who underwent their first kidney transplantation between January 2008 and December 2014 were enrolled. We excluded combined and ABO-incompatible transplantations and patients with pre-transplantation anti-HLA immunization. Pre-transplant immunization was defined as at least one anti-HLA antibody with mean fluorescence intensity (MFI) superior at 500. Early graft failures, defined by primary graft dysfunction and vascular thrombosis arising during the first week after transplantation, have been excluded.
Results. 303 kidney transplant recipients were included. Recipient age was 52.2 ± 14 years. 204 (67.3%) patients were treated with a tacrolimus-based immunosuppressive regimen. During the follow-up period (5.1 [3.0; 7.3] years), 44 (14.5%) patients developed dnDSA, with a median MFI of 3600 [1500; 10000]. Among them, 7 (15.9%) had anti-class I DSA, 27 (61.4%) had anti-class II DSA and 10 (22.7%) had anti-class I and anti-class II DSA. Detection of dnDSA occurred 2.3 [1.1; 4.3] years after transplantation. Graft survival was 85% at the end of follow-up and AMR occured in 28 (9.2%) patients, including 23 (82.1%) with dnDSA.
Independent predictive factors of dnDSA were a history of T-cell mediated rejection (TCMR) (HR 1.02 [1.01-1.03], p=0.002), DR-b1 mismatches (HR 2.65 [1.55-4.54], p<0.001) and calcineurin inhibitor (CNI) discontinuation (HR 2.04 [1.03-4.02], p=0.04). Tacrolimus-based immunosuppressive regimen was associated with a lower risk of dnDSA (HR 0.47 [0.24-0.90], p=0.023).
Conclusions. In non-sensitized kidney transplant recipient, TCMR, DR-b1 mismatches, and CNI discontinuation contribute to dnDSA development. On the contrary, tacrolimus-based regimen seems to have a protective effect.
CITATION INFORMATION: Marron-Wojewodzki M, Szwarc I, Rene C, Mourad G, Le Quintrec M. Tacrolimus Appears to Be a Protective Factor for De Novo DSA Formation in Non-Sensitized Kidney Transplant Patients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Marron-Wojewodzki M, Szwarc I, Rene C, Mourad G, Quintrec MLe. Tacrolimus Appears to Be a Protective Factor for De Novo DSA Formation in Non-Sensitized Kidney Transplant Patients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/tacrolimus-appears-to-be-a-protective-factor-for-de-novo-dsa-formation-in-non-sensitized-kidney-transplant-patients/. Accessed May 13, 2025.« Back to 2017 American Transplant Congress