OR36: IMPACT OF PREEMPTIVE PERIOPERATIVE DESENSITIZATION ON DECEASED DONOR TRANSPLANTATION AND DSA ELIMINATION

• Published in: Human immunology Vol. 75; p. 31
• Main Authors: Kimball, Pam, McDougan, Felecia
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2014
• ISSN: 0198-8859; 1879-1166
• DOI: 10.1016/j.humimm.2014.08.039

Sensitized kidney tranplant (KT) patients have poorer graft survival due to DSA induced chronic rejection. While preoperative desensitization effectively minimizes DSAs, it is not suitable for patients dependent on deceased donation (DD). To improve graft survival among sensitized DDKT patients, we developed a protocol to preemptively desensitize immediately after KT using PP/IVIG or IVIG alone. This report summarizes the impact of both treatments upon clinical outcome and posttransplant DSA. 253 patients were stratified perioperatively by assigning points for PRA, FCXM, DGF and histology. Patients with ⩾3 points received PP/IVIG (n=40); 2 points got IVIG (n=28); ⩽1 point got standard treatment (ST) (n=167). Serums were collected quarterly for 1year posttransplant and tested for DSA by luminex. Five-year clinical outcomes were collected. As expected, PP/IVIG and IVIG patients were more sensitized than ST and had higher PRAs (64±29% vs 53±40% vs. 26±32%, p<.05) and more FCXM+/DSA+patients (80% vs. 68% vs. 11%, p<.05). PP/IVIG had more rejections than other groups (20% vs 11% vs 7%, p<.05). However, 5year graft survival was equivalent between groups (82%; 75%, 80%, p=ns). Posttransplant DSAs were eliminated among more PP/IVIG than IVIG patients (67% vs. 33%, p<.05). De novo DSA occurred equally in PP/IVIG or IVIG groups (20%, p=ns). Outcome metrics were revisited based upon DSA loss or persistence. Rejection frequency was equivalent to ST (5%) among PP/IVIG patients with DSA loss or persistence (10%, p=ns) and IVIG patients with DSA loss (0%, p=ns). In contrast, IVIG patients with persistent DSA had more rejection (20%, p<.05). Graft survival was ⩾90% among ST, PP/IVIG patients and IVIG patients with DSA loss as well as PP/IVIG patients with DSA persistence. In contrast, graft survival was poor among IVIG patients with persistent DSA (p<.05). After perioperative desensitization, graft survival among sensitized patients was now equivalent to non-sensitized individuals. PP/IVIG treatment was more effective than IVIG in DSA elimination, rejection prevention and graft survival among patients with persistent DSA.