Donor specific anti HLA sensitization is associated with inferior short term outcome in ABO- incompatible renal transplantation

Abstract

Sixty six patients were evaluated for donor specific anti HLA sensitization before they received ABO incompatible kidney transplantation. Each recipient was evaluated by complement dependent cytotoxicity (CDC) crossmatch, flow cytometric crossmatch, single antigen bead assay (SAB) and lysate based solid phase crossmatch .The desensitization protocol was started10 to 12 days prior kidney transplant for ABO incompatible and anti HLA incompatible transplants at our center. Patients were evaluated for antibody mediated rejection (ABMR), donor specific anti HLA sensitization, graft survival with anti HLA DSA positivity in ABO-incompatible kidney transplant recipients.Antibody mediated rejection (ABMR) was seen in five (7.5%) out of 66 patients. In non-sensitized group-A, ABMR was seen in 4.0% and in sensitized group (group-B) ABMR was seen in 18.75% with DSA positivity. Graft loss within one month post-transplant was seen in 2 patients due to ABMR in the sensitized group -B with pre-transplant positive DSA and in none in the non-sensitized group-A (p value = 0.05). Both these two patients sensitized group -B had flow CM, SAB DSA and Lysate CM positivity, with total MFI strength by SAB was above 5000, these two patients with CDC and flow CM negative after desensitization and had SAB DSA MFI strength came down to ≤1000.In this study patient survival was 97% and graft survival was 95% at one year, at four years Patient survival was 91.6% and graft survival was 91.5% follow up period. Anti HLA DSA positivity with ABO- incompatibility is associated with poor graft survival.