De Novo DSA in the Setting of Stable Renal Allograft Function is a Benign Finding. (July 2018)

• Record Type: Journal Article
• Authors: Knight, Richard; Eagar, Todd; Nguyen, Duc; Graviss, Edward; Kuten, Samantha; Patel, Samir; Moore, Linda; Gaber, Osama
• Is Part Of: Transplantation. Volume 102(2018)Supplement 7S-1
• Publication Date: 2018-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/01.tp.0000542596.39174.b7
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : We sought to determine the long-term outcome of renal allograft recipients that developed de novo DSA (dnDSA) in the setting of stable allograft function. Methods: A retrospective single-center review of 150 consecutive renal allograft recipients transplanted between January 2008 and May 2009. DnDSA was performed at 3, 6, 9, 12, and every 6 months thereafter. DnDSA were defined as HLA-A, B, Cw, DR, DQ, or DP antibodies directed against the donor, that were not present pre-transplant. All dnDSA had a median florescence index of greater than or equal to 2000 and were confirmed by repeated testing. Measurement of C1q binding was not available. Thirteen recipients were excluded because of pre-transplant DSA (n=11) or initial non-function (n=2). Results: The study cohort included 137 recipients, with 58% male, mean age 49 ± 13 years, 86% primary transplants and 44% living donors. Median graft survival was 76 (range 6-110) months. There were 115 recipients with no DSA (Group 1), 17 recipients with dnDSA and stable graft function (Group 2), and 5 recipients with dnDSA associated with an acute rejection (Group 3). Median time to first dnDSA was 26 (range 6-96) months. Death censured graft survival was compared between groups 1 and 2, as shown below. All 5 recipients of Group 3 lost their grafts at a median of 38 (range 37-49) months post-transplant. Mean serum creatinines of Groups 1 and 2 were 1.2±0.4 vs. 1.4±0.6 at 3 years, 1.2±0.4 vs. 1.3±0.5 at 5 years, and 1.3±0.8 vs.1.1±0.4 mg/dl at 7 years post-transplantation (p=ns). Conclusion: In this cohort, development of dnDSA in a recipient with stable graft function had no detrimental impact on long-term graft survival, whereas dnDSA associated with an acute rejection universally resulted in graft loss. Figure. No caption available.