De novo donor specific antibodies (dnDSA) are associated with antibody mediated rejection (ABMR) and graft failure following kidney transplantation. The impact of induction immunosuppression on dnDSA is unknown. We addressed this question in 114 consecutive moderately sensitized [DSA+ and flow crossmatch (-)] recipients of deceased donor renal transplants between 12/09 and 11/11. Patients were divided in 2 groups based on induction therapy (thymoglobulin [ATG], Thymo®, Genzyme or basiliximab, Simulect®, Novartis). De novo DSA was defined as the absence of pre-transplant DSA (MFI < 300; LabScreen Single Antigen Beads, OneLambda, Inc) increasing at least three-fold (> 900 MFI) post-transplant. Antibodies were verified by analysis of MFI values and patterns of epitope specificity in a blinded fashion. Patients were followed for a mean of 12.4 ±3.7 months. The ATG (4.98 mg/kg ±7.9) cohort had significantly higher PRA and received more plasmapheresis and IVIG.
|Basiliximab (n=28)||ATG (n=86)|
|Mean (%), SD||Mean (%), SD||p|
|Recipient age (years)||50.57±13||48.48±12.33||0.44|
|Serum creatinine at 1 year (mg/dL)||1.43±0.43||1.46±0.61||0.83|
|eGFR at 1 year (mL/min)||52.75±16.97||56.16±25.08||0.53|
|DSA at 1 week||657.75±372.35||1516.61±2907.53||0.01|
|DSA at 1 year||2188.13±2548.43||1789.69±2460.47||0.59|
Kaplan-Meier survival analyses demonstrated that the incidence of dnDSA (HR 0.33 [0.08 to 1.40], P = 0.03) and ABMR (HR 0.27 [0.05 to 1.52], P = 0.03) was significantly lower in the ATG group.
Multivariate stepwise cox regression analyses demonstrated that ATG induction was the only significant predictor of both ABMR(HR 0.26 [0.07 to 0.95], P=0.04) and dnDSA (HR 0.26 [0.70 to 0.95], P=0.04). This study demonstrates for the first time that induction with ATG is associated with a reduction in dnDSA and ABMR when compared with basiliximab.
To cite this abstract in AMA style:Mako M, Hager D, Muth B, Kaufman D, Ellis T, Djamali A. Thymoglobulin Is Associated with a Significant Reduction in De Novo Donor-Specific Antibodies and Antibody Mediated Rejection in Moderately Sensitized Renal Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/thymoglobulin-is-associated-with-a-significant-reduction-in-de-novo-donor-specific-antibodies-and-antibody-mediated-rejection-in-moderately-sensitized-renal-transplant-recipients/. Accessed August 21, 2018.
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