The Fate of Renal Allografts in Patients with Donor Specific Antibodies
R Szumski, MP Martinez Cantarin, BW Colombe, JL Farber. Thomas Jefferson University Hospital, Philadelphia, PA
Background: Antibodies to donor HLA antigens (DSAs) are a feature of the allogenic immune response to a renal transplant. Despite the growing awareness of antibody-mediated rejection, the relationship between DSAs and both acute and chronic allograft dysfunction needs to be better defined. To this end, the present study is a retrospective analysis from our institution of the fate of all kidney transplant recipients in whom DSAs were detected.
Design: All patients (1981-2007) were screened post-transplantation for Class I DSAs, whereas Class II screening began in 2003 with the appearance of solid state technology. Diagnoses of acute antibody-mediated rejection (AMR), acute cellular rejection (AR), or chronic, active T cell-mediated rejection (CR) were based on the Banff '05 criteria (applied retrospectively to biopsies prior to 2007).
Results: 76 patients with DSAs had obtainable records. 6 had a nephrectomy within 1 month for surgical complications and were not studied. 39 patients had 2 or more transplants. Of these, 9 transplants had DSAs. Thus, 70 patients with 79 renal allografts developed DSAs (42 males and 37 females). Class I antibodies (Abs) developed in 67 transplants. Class II Abs were present in 33 of 52 transplants screened, and both Class I and II in 21. Acute antibody-mediated rejection occurred in 8 (10%). All had Class I Abs. Of the 4 patients screened, 2 also had Class II Abs. Acute cellular rejection occurred in 31 (39%). 16 had Class I Abs. Of the 22 patients screened, 4 had Class II Abs alone and 11 Class I and II Abs. 8 class I patients had A2, 6 A1, and 4 B44 Abs. 3 Class II patients each had DQ2, DR1, or DR15 Abs, respectively. Chronic, active T cell-mediated rejection was diagnosed in 45 (60%) (the mean time to CR was 18 months). Of these 45, 22 did not have a previous episode of AMR or AR. 5 previously had AMR and 18 AR. Fifty-two allografts of the 79 allografts (66%) required a nephrectomy (mean time to surgery 24 months). 6 transplants experienced acute tubular damage without evidence of AMR, AR, or CR.
Conclusions: Over 75% of patients with DSAs experienced some form of rejection (AMR, AR, and/or CR (60%)) with a mean for CR of 18 months following transplantation. Almost 70% required a transplant nephrectomy within a mean of 2 years. Our data clearly indicate that patients with DSAs fared quite poorly. In general, the appearance of DSAs in a renal transplant recipient indicates the likelihood of a strong anti-allograft diathesis.
Category: Kidney (does not include tumors)
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 225, Wednesday Afternoon