Post-transplant DSA Monitoring May Predict Antibody-mediated Rejection in Sensitized Kidney Transplant Recipients.

Mohamed MA, Muth B, Vidyasagar V, Foley D, Fernandez L, Hofmann RM, Mezrich J, Pirsch J, Odorico J, d'Alessandro T, Bellingham J, Torrealba J, Kaufman D, Djamali A.

Clinical Transplants 2011, Chapter 40

Abstract

We examined whether changes in posttransplant highest intensity donor specific anti-HLA antibody specificity (DSAmax) measured by single antigen bead via Luminex (One Lambda, Inc.) were associated with antibody-mediated rejection (AMR). We conducted a retrospective analysis examining risk factors for AMR in 116 consecutive patients who underwent desensitization between 1/1/2009 and 9/1/2010. All patients had a negative flow cytometry crossmatch. The mean patient age at transplant was 46.4 +/- 4 years.The mean peak PRA (panel reactive antibody) and DSAmax at transplant were 40 +/- 6% and 894 +/- 150 mean fluorescent intensity (MFI), respectively. The mean time to rejection was 1.5 +/- 0.4 months. Cox regression analyses demonstrated that an increase in DSAmax by one week after transplant was significantly associated with AMR (pure or mixed). A rise in DSAmax greater than 500 MFI at 1 week was associated with a 2.6 times greater risk of rejection (HR 2.6, 95% CI 1.1 - 6.3, p = 0.02). We conclude that a rise in DSAmax at one week is an independent risk factor forAMR and that osttransplant DSA monitoring strategies may reduce the risk of AMR n sensitized patients.