Induction and Donor Specific Antibodies in Low Immunologic Risk Kidney Transplant Recipients

Natalie M. Bath, Arjang Djamali, Sandesh Parajuli, Didier A. Mandelbrot, Glen Leverson, Luis G. Hidalgo, Thomas Ellis, Jillian L. Descourouez, Margaret R. Jorgenson, Dave Hager, Dixon B. Kaufman, Robert R. Redfield
2020 Kidney360  
Optimal induction for patients without pre-transplant donor specific antibodies (DSA) is poorly defined. The goal of this study was to compare the incidence of de novo DSA (dnDSA) and graft outcomes between induction therapies in patients with a negative virtual cross match (VXM). Methods: A retrospective chart review was performed which identified 782 patients with a negative VXM who underwent kidney transplantation at a single high-volume institution between January 2013 and May 2017.
more » ... d May 2017. Kaplan-Meier analysis was used to assess the incidence of dnDSA and allograft survival between induction therapies in this group. DnDSA is defined as the development of new post-transplant DSA, at any MFI level. Results: Induction therapy included alemtuzumab (N=87, 11.1%), basiliximab (N=522, 66.8%), and anti-thymocyte globulin (ATG) (N=173, 22.1%). One-year graft survival was similar between groups (alemtuzumab 100%, basiliximab 98.2%, ATG 98.8%). Incidence of acute rejection at one year was less than 2% and not different between the three groups. Alemtuzumab was associated with the highest incidence of dnDSA at 13.8% compared to 5.2% and 8.1% in basiliximab and ATG groups at 1 year, respectively (p=0.009). In multivariate regression analyses, alemtuzumab retained its significant association with dnDSA HR 2.5 (95% CI 1.51-4.25, p=0.0004). Conclusions: In summary, alemtuzumab was associated with a higher rate of dnDSA development in patients with a negative VXM; however, this finding was not associated with rejection or graft failure.
doi:10.34067/kid.0000122020 fatcat:xk6tyrh4abbipgbaikf4k6sxsy