A clearer understanding of the patterns of glomerular filtration rate (GFR) decline following donor-specific antibody (DSA) development and the factors that might be associated with a faster decline in function are needed. Herein, we study post-DSA GFR decline in 52 DSA-positive renal transplant patients.

Methods: We performed a retrospective analysis of de novo DSA positive transplant patients transplanted at a single transplant center between 11/1999 and 4/2011. All patients underwent frequent HLA IgG serial antibody monitoring by LABScreen® single antigen beads with IgG3 testing after DSA was found positive. Only patients with an eGFR>50 at the time of DSA were included in the analysis. Latent class mixed models were fit to all available eGFR measurements post-DSA. The number of latent classes was identified based on BIC. After patients were classified according to posterior probabilities, variables associated with class membership were identified.

Results: A total of 52 patients were included in the analysis. Two latent classes were identified (Figure): patients with stable eGFR post-DSA (n=28) and patients with rapidly declining eGFR post-DSA (n=24). Patients in the declining trajectory (compared to the stable eGFR cohort) were more likely to have had a living donor (33% vs 7%), have experienced an acute rejection episode (71% vs 25%), have IgG3+ DSA (65% vs 9%), died during follow-up (38% vs 14%), or experience graft failure (58% vs 25%). There were not substantial differences between the classes in age at transplant, race, gender, or delayed graft function.

Conclusion: Our findings support the idea that patients may take clear clinical courses after the onset of DSA. Those who develop or have a history of acute rejection and those who have IgG3 positive DSA are more likely to have a fast decline in eGFR and proceed to allograft failure and possibly death.

CITATION INFORMATION: Beaumont J., Briley K., Maldonado A., Haisch C., Bolin P., Kendrick S., Jones H., McLawhorn K., Leeser D., Rebellato L., Everly M. Two Trajectories of Post-DSA eGFR after Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

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