Histocompatibility Posters

Tuesday July 03, 2018 from 16:30 to 17:30

Room: Hall 10 - Exhibition

P.308 Risk Factors of De Novo Sensitization and DSA in Long-Term Renal Transplant Patients with Stable Graft Function

Efstratios Kasimatis, Greece

Department of Nephrology
Hippokration Hospital of Thessaloniki

Abstract

Risk Factors of De Novo Sensitization and DSA in Long-Term Renal Transplant Patients with Stable Graft Function

Efstratios Kasimatis1, Asimina Fylaktou2, Theodoros Karampatakis2, Maria Schoina1, Charalampos Zarras2, Aikaterini Anastasiou2, Marianthi Papachristou2, Anna Boukla2, Aikaterini Papagianni1.

1Department of Nephrology, Hippokration Hospital, Thessaloniki, Greece; 2National Peripheral Histocompatibility Center, Immunology Department, Hippokration Hospital, Thessaloniki, Greece

Introduction: De novo Donor Specific Antibodies (DSA) are associated with antibody-mediated rejection leading to late renal transplant failure. Risk factors for sensitization would either increase graft immunogenicity, as in less HLA compatibility, or the recipient immune system’s ability to respond to alloantigens, as is the case in inadequate immunosuppression.
Materials and Methods: We studied risk factors for anti-HLA antibodies in 89 renal transplant patients (47 males) with stable renal function, up to 27 years after renal transplantation. Patients were classified into 2 groups according to HLA compatibility between donor and recipient, group A (1-4 out of 8 matches) and group B (5-8 out of 8 matches). Anti-HLA antibodies were detected using Single Antigen Bead Luminex assay and were further classified into DSA and non-DSA.
Results and Discussion: De novo anti-HLA were detected in 40 patients, DSA in 19 (21.8%) and non-DSA in 19, as well. DSA patients were younger than non-DSA at transplantation (median 27 vs 37 years old, p=0.025) with functional renal grafts for 11±5 years, while patients with no detectable anti-HLA had recorded functional grafts for 14.4±8.6 years (p=0.048). After antibodies detection, patients were followed up to 25 months and those with DSA were more likely to have graft loss (p=0.043). HLA group A was consisted of 49 (56%) transplant recipients while 38 (44%) were classified in group B, with functional grafts for 10.9±6.7 and 14.8±8.5 years, respectively (p=0.019). Less compatible group A patients had more anti-HLA antibodies than group Β (p=0.009) and this correlation was retained for DSA patients in particular (p=0.017). Presensitization and DGF were associated with anti-HLA detection but only the former correlated with DSA (p=0.02). Severe CMV infection dictates temporary attenuation or even withdrawal of the immunosuppression and admission for CMV was correlated with DSA (p=0.001) but no other anti-HLA detection. Concerning the immunosuppressive regimen, those who received mTORi as maintenance therapy, in an attempt to minimize CNI toxicity, had more DSA (p=0.015), but no more non-DSA. In a multivariate analysis including HLA compatibility, presensitization, CMV infection and mTORi use as predictive factors, CMV infection was an independent predictor of DSA (p=0.044, OR=8.97, CI: 1.06-75.9).
Conclusion: HLA compatibility is probably correlated with DSA in a context of a more general anti-HLA sensitization and both of them have a negative effect on long term renal graft outcome. Modifiable factors regarding proper immunosuppression seem to have a more specific effect on DSA.

Presentations by Efstratios Kasimatis



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