Purpose: To investigate which risk factor affects the development dnDSA.Methods: 315 patients (pts) with available antibodies study and follow upgreater then 6 months (who un derwent KTx from January 2005 to December2017) are object of our study. Mean recipients age was 52 years (range 24-71), mean donors age was 50 years (range 15-81). Mean follow up post KTxwas 59 months (range 10-60).Post transplant sera were studied at months 3 and then yearly, (or by clinicalneeds) to access the presence of dnDSA. Screening was obtained with class Iand II Flow PRA test, in positive sera class I and II Luminex single antigenbeads was performed.Patients were divided in groups depending of immunosuppressive protocol:tacrolimus and mycophenolic acid (MPA) (n = 153), cyclosporine (CsA) andMPA (n = 37), CsA and Proliferation Signal Inhibitor (PSI) (sirolimus oreverolimus) (n = 99), PSI and MPA (n = 18), other (n = 8).Development of dnDSA was correlated with known risk factors : pretransplant class I and II PRA, donors age, recipients age, immunosuppressiveprotocols.Lastly 10 years graft survival and renal function (assessed by creatinine)was compared for pts with and without dnDSA.Results: In our study 59 patients (19%) developed dnDSA after a mean timeof 32 months (range 1-136) since KTx.Immunosuppressive protocols showed similar incidence of dnDSA:tacrolimus+MPA = 26 pts (17%), CsA+MPA = 10 pts (27%), CsA+PSI = 17pts (17.2%), PSI+MPA = 6 pts (33%). (p=ns).Ten years graft survival was adversely influenced by dnDSA (78.0% vs.90.7%) (p = 0.017).Median last serum creatinine level was higher in patients with dnDSApositivity (2.0 vs. 1.5 mg/dl) (p = 0.045).Among all the variables examinated, dnDSA is positively influenced only byrecipients age: patients under 50 years of age more prone to develop dnDSA(p = 0.013).Conclusion: In our experience the only variable influencing development ofdnDSA is the recipient age minor of 50 years.
DE NOVO DONOR SPECIFIC ANTIBODIES (DNDSA) AND KIDNEY TRANSPLANTATION (KTX) OUTCOME: A SINGLE CENTER EXPERIENCE
Poggi Elvira;
2019
Abstract
Purpose: To investigate which risk factor affects the development dnDSA.Methods: 315 patients (pts) with available antibodies study and follow upgreater then 6 months (who un derwent KTx from January 2005 to December2017) are object of our study. Mean recipients age was 52 years (range 24-71), mean donors age was 50 years (range 15-81). Mean follow up post KTxwas 59 months (range 10-60).Post transplant sera were studied at months 3 and then yearly, (or by clinicalneeds) to access the presence of dnDSA. Screening was obtained with class Iand II Flow PRA test, in positive sera class I and II Luminex single antigenbeads was performed.Patients were divided in groups depending of immunosuppressive protocol:tacrolimus and mycophenolic acid (MPA) (n = 153), cyclosporine (CsA) andMPA (n = 37), CsA and Proliferation Signal Inhibitor (PSI) (sirolimus oreverolimus) (n = 99), PSI and MPA (n = 18), other (n = 8).Development of dnDSA was correlated with known risk factors : pretransplant class I and II PRA, donors age, recipients age, immunosuppressiveprotocols.Lastly 10 years graft survival and renal function (assessed by creatinine)was compared for pts with and without dnDSA.Results: In our study 59 patients (19%) developed dnDSA after a mean timeof 32 months (range 1-136) since KTx.Immunosuppressive protocols showed similar incidence of dnDSA:tacrolimus+MPA = 26 pts (17%), CsA+MPA = 10 pts (27%), CsA+PSI = 17pts (17.2%), PSI+MPA = 6 pts (33%). (p=ns).Ten years graft survival was adversely influenced by dnDSA (78.0% vs.90.7%) (p = 0.017).Median last serum creatinine level was higher in patients with dnDSApositivity (2.0 vs. 1.5 mg/dl) (p = 0.045).Among all the variables examinated, dnDSA is positively influenced only byrecipients age: patients under 50 years of age more prone to develop dnDSA(p = 0.013).Conclusion: In our experience the only variable influencing development ofdnDSA is the recipient age minor of 50 years.| File | Dimensione | Formato | |
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