Early immunosuppression treatment correlates with later de novo donor-specific antibody development after kidney and pancreas transplantation

• Published in: Clinical transplantation 2015-12, Vol.29 (12), p.1119-1127
• Main Authors: Pelletier, Ronald P., Rajab, Amer A., Diez, Alejandro, DiPaola, Nicholas R., Bumgardner, Ginny L., Elkhammas, Elmahdi A., Henry, Mitchell L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cohort Studies; donor-specific antibody; Female; Follow-Up Studies; graft outcomes; Graft Rejection - blood; Graft Rejection - diagnosis; Graft Rejection - immunology; Graft Survival - immunology; Humans; immunosuppression; Immunosuppressive Agents - therapeutic use; Isoantibodies - blood; Isoantibodies - immunology; kidney transplant; Kidney Transplantation - adverse effects; Male; Middle Aged; Pancreas Transplantation - adverse effects; Postoperative Complications; Prognosis; Risk Factors; survival; Tissue Donors; Young Adult
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12636

Background De novo donor‐specific antibodies (dnDSA) post‐transplant correlate with a higher risk of immunologic graft injury and loss following kidney and pancreas transplantation. Post‐transplant dnDSA can occur within the first post‐transplant year. Methods In this study, 817 of 1290 kidney and simultaneous kidney/pancreas recipients were tested for dnDSA post‐transplant. Recipient immunosuppressive treatment at one, three, six, and 12 months post‐transplant was correlated with dnDSA incidence by univariate and multivariate analyses. Results The overall incidence of dnDSA was 21.3% detected a median of 3.5 yr post‐transplant. By univariate analysis, the immunosuppressive treatment at all time points correlated with dnDSA (p < 0.01). Month 6 treatment correlated best in multivariable analysis (p = 0.004). At six months, recipients receiving rapamune/mycophenolic acid (Rapa/MPA) had the highest dnDSA incidence at five yr (25.3%) and last follow‐up (30.7%), those treated with cyclosporine/rapamune (CNI/Rapa) had the lowest incidence at five yr (10.8%) and last follow‐up (18.6%), and cyclosporine/mycophenolic acid (CNI/MPA) treatment had an intermediate incidence at five yr (16.7%) and last follow‐up (20.4%) (p < 0.01). Six‐month CNI/MPA and Rapa/MPA treatment significantly correlated with dnDSA (hazard ratios of 2.36 and 1.80, respectively) by Cox proportional hazards regression modeling. Conclusion The risk of post‐transplant dnDSA development correlates with early immunosuppressive management.