Abstract: SA-PO021
De Novo Complement-Activating Donor Specific Antibodies Are Highly Responsive to Therapy
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Sigurjonsdottir, Vaka Kristin, Stanford University Medical Center, Stanford, California, United States
- Grimm, Paul C., Stanford University Medical Center, Stanford, California, United States
Background
After recognizing that graft failure was more common in our patients with positive de Novo DSAs (dnDSAs) by C1q we started using the C1q assay as a guide to therapy of rejection. The aim of this study was to investigate response to treatment as well as characteristics and allograft function of pediatric renal transplant patients with positive dnDSA by C1q.
Methods
Retrospective cohort of 35 pediatric renal transplant patients, age 1-20 years, who formed C1q dnDSAs identified by screening or investigation of allograft dysfunction with at least 6 month follow up. C1q dnDSAs were identified by single-antigen flow bead assay. Outcomes were evolution of C1q dnDSAs and graft function in patients with C1q. GFR was estimated using Schwartz method. The same pathologists reviewed all biopsies.
Results
Followup was 36 months (11-96) (Median (range).) Figure 1 shows evolution of C1q. Therapy consisted of Solumedrol (n=19), Thymoglobulin (n=15), IVIG (n=23), Rituximab (n=20) and 1 received Bortezomib / plasmapheresis. Steroid free immunosuppression was converted to steroid based in 9 patients. Maintenance immunosuppression was adjusted/increased when appropriate, adherence anticipatory guidance was provided as needed. During the follow up period, 5 patients, had allograft failure. Figure 2 shows Kaplan–Meier curves for renal survival.
Conclusion
Interventions directed against complement-binding DSA at our center, reduced or eliminated the C1q biomarker significantly. Persistence of C1q antibodies was associated with worse allograft outcome