The Impact of Pre-Transplant Donor Specific Antibodies (DSA) on AMR Rates in HIV-Infected Kidney Transplant Recipients Inducted with IL-2 RA

S. Farouk, B. Rollins, V. Delaney, N. Singh, V. Sehgal, R. Kent, M. Menon, R. Shapiro, S. Florman, G. DeBoccardo.

Recanati Miller Transplant Institute, Icahn School of Medicine at Mt. Sinai, New York, NY.

Meeting: 2018 American Transplant Congress

Abstract number: A115

Keywords: Graft survival, HIV virus, HLA antibodies, Kidney transplantation

Session Information

Session Name: Poster Session A: Kidney Acute Antibody Mediated Rejection

Session Type: Poster Session

Date: Saturday, June 2, 2018

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall 4EF

Background: 1-year rejection rates in HIV-infected kidney transplant recipients range from 15-40%, compared to overall rejection rates of 10% in HIV-negative patients. We report the impact of DSA on outcomes of HIV-infected kidney transplant recipients who received IL-2RA induction therapy at our center.

Methods: This study is an IRB-approved, single center, retrospective study of adult HIV-infected patients with a kidney transplant performed between 5/2009 to 12/2014 with 3-year follow up for each patient.

Results: 11/42 (26%) had pre-transplant donor specific antibodies (DSAs), defined as MFI > 1000 to at least one class I or class II locus. All of these patients received IVIG at the time of transplant. 8/11 (73%) patients with pre-transplant DSA had a total of 11 biopsy proven rejections (BPRs); 2/11 (18%) allografts were explanted because of rejection. 7/11 (64%) rejections were either acute or chronic AMR. 5/8 (63%) patients with pre-transplant DSA and a BPR had at least one episode of AMR.

15/31 (48%) of patients without pre-transplant DSA had at least one episode of biopsy proven rejection (BPR) and a total of 13 BPRs. 12/13 (92%) rejections were acute cellular rejections. Only 1/13 (8%) patients without DSA had an AMR, which was significantly lower than the AMR incidence in the pre-transplant DSA group (p = 0.008). 1/31 (3%) allograft in this group was explanted, compared to 2/11 (18%) in the DSA group.

Death censored graft survival at 3 years was 9/11 (82%) in the DSA group compared to 30/31 (97%) in those without DSA.

Conclusions: The rates of AMR and death censored graft loss in HIV-infected kidney transplant recipients induced with IL-2RA are higher in those with pre-transplant DSA. Further studies should evaluate if the presence of DSAs in this patient population warrants more aggressive induction and maintenance immunosuppressive therapy.

CITATION INFORMATION: Farouk S., Rollins B., Delaney V., Singh N., Sehgal V., Kent R., Menon M., Shapiro R., Florman S., DeBoccardo G. The Impact of Pre-Transplant Donor Specific Antibodies (DSA) on AMR Rates in HIV-Infected Kidney Transplant Recipients Inducted with IL-2 RA Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Farouk S, Rollins B, Delaney V, Singh N, Sehgal V, Kent R, Menon M, Shapiro R, Florman S, DeBoccardo G. The Impact of Pre-Transplant Donor Specific Antibodies (DSA) on AMR Rates in HIV-Infected Kidney Transplant Recipients Inducted with IL-2 RA [abstract]. https://atcmeetingabstracts.com/abstract/the-impact-of-pre-transplant-donor-specific-antibodies-dsa-on-amr-rates-in-hiv-infected-kidney-transplant-recipients-inducted-with-il-2-ra/. Accessed November 21, 2024.

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