Urinary Tract Infections May Be Associated with De Novo Donor-Specific Anti-Human Leucocyte Antigen Antibodies: Single-Center Study

M. Everly,¹ A. Babu,¹ K. Briley,² P. Bolin,² S. Kendrick,³ H. Jones,³ K. McLawhorn,³ A. Maldonado,⁴ C. Haisch,² D. Leeser,² L. Rebellato.²

¹Terasaki Research Institute, Los Angeles
²East Carolina University, Greenville, NC
³Eastern Nephrology Associates, Greenville, NC
⁴Vidant Medical Center, Greenville, NC.

Meeting: 2018 American Transplant Congress

Abstract number: D147

Keywords: Alloantibodies, Infection, Urinalysis

Session Information

Session Name: Poster Session D: Kidney Infectious

Session Type: Poster Session

Date: Tuesday, June 5, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Introduction: We have recently shown that immunosuppression reduction with BK virus is associated with the development of de novo donor anti-human leukocyte antigen-specific antibodies (dnDSA). We hypothesized that bacterial infections, especially urinary tract infections, may also be associated with the development of dnDSA.

Materials and Methods: A single-center retrospective cohort study of 123 out of the 152 patients transplanted from March 2007 to 2010. Twenty-six patients were excluded due to the presence of “preformed DSA”. Three patients were excluded because of missing data, and loss to follow-up. Development of dnDSA was measured using single antigen beads (One Lambda, CA) at 1, 3, 6, and 12 months then biannually. dnDSA was considered positive if the MFI was ≥1000.

Results: Median follow up of 123 patients was 52 months (IQR 44-68). 87(71%) recipients had bacterial/fungal/viral infections. 73 (59%) had urinary tract infections. 49 of 123 patients developed dnDSA. In 29 (59%) patients, the dnDSA was directed against HLA class II antigens. In univariate logistic regression analysis UTI and recurrent UTI were associated with development of dnDSA (p=0.014 and p=0.012 respectively). Opportunistic viral infections with or without UTI were also associated with dnDSA (p<0.0001 and p=0.001, respectively). In multivariate analysis, opportunistic infections (p=0.005) especially BK virus (p= 0.011) and UTI (p= 0.041) were associated with dnDSA. None of the infections, either bacterial/viral or fungal infections, were associated with predicting graft survival. Only dnDSA was associated with prediction of graft survival (Hazard ratio 3.4, 95% CI 1.34 – 8.65).

Conclusions: From this study, we have shown that post-transplant UTI is independently associated with the development of dnDSA. Further analysis will be conducted to determine if this risk is immunosuppression reduction related as it was seen in the cases of BK-viremia.

CITATION INFORMATION: Everly M., Babu A., Briley K., Bolin P., Kendrick S., Jones H., McLawhorn K., Maldonado A., Haisch C., Leeser D., Rebellato L. Urinary Tract Infections May Be Associated with De Novo Donor-Specific Anti-Human Leucocyte Antigen Antibodies: Single-Center Study Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Everly M, Babu A, Briley K, Bolin P, Kendrick S, Jones H, McLawhorn K, Maldonado A, Haisch C, Leeser D, Rebellato L. Urinary Tract Infections May Be Associated with De Novo Donor-Specific Anti-Human Leucocyte Antigen Antibodies: Single-Center Study [abstract]. https://atcmeetingabstracts.com/abstract/urinary-tract-infections-may-be-associated-with-de-novo-donor-specific-anti-human-leucocyte-antigen-antibodies-single-center-study/. Accessed May 16, 2025.

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