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

Ronald P. Pelletier, Amer A. Rajab, Alejandro Diez, Nicholas R. DiPaola, Jr., Ginny L. Bumgardner, Elmahdi A. Elkhammas, Mitchell L. Henry

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1119-1127
Number of pages9
JournalClinical Transplantation
Volume29
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • Donor-specific antibody
  • Graft outcomes
  • Immunosuppression
  • Kidney transplant
  • Survival

ASJC Scopus subject areas

  • Transplantation

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