Transplant Surgery Fellow
University of Wisconsin
Incidence, Outcomes and Predictors of de novo Donor Specific Antibody in Pancreas Transplantation
Robert Redfield1, Tiffany J Zens1, Brian C Eby1, Joseph R Scalea1, Thomas M Ellis2, Jon S Odorico1.
1Transplant Surgery, University of Wisconsin, Madison, WI, United States; 2Pathology, University of Wisconsin, Madison, WI, United States
Background: There exists limited data on the development of de novo donor specific antibody (dnDSA) in pancreas transplantation. We therefore sought to determine the incidence, outcomes and risk factors for dnDSA appearance after pancreas transplantation.
Methods: This is a single center retrospective study between 2010 and 2013 of pancreas transplants performed at the University of Wisconsin. Graft survival was determined using Kaplan-Meier analyses. Regression analysis was performed to determine risk factors for the development of dnDSA. DSA was measured pre-transplant and post-transplant at 1,3,6 months, and then yearly.
Results: 153 consecutive pancreas transplants were performed during the study period. 94 (61%) were simultaneous pancreas kidney transplants (SPK) and 59 (38.6%) were pancreas transplants alone (PTA). All 153 patients received induction immunosuppression. 96 (62.7%) received basiliximab, 51 (33.3%) received anti-thymocyte globulin and 6 (3.9%) received alemtuzumab. Maintenance immunosuppression consisted of tacrolimus, mycophenolate and prednisone, except for those patients receiving alemtuzumab whom underwent early steroid withdrawal. DnDSA was found in 24 (15.7%) of patients with a median follow-up of 1.9 yrs (0.03 – 4.1). Of those patients that developed dnDSA, 5 (20.8%) were to class I HLA antigens only, 12 (50%) to class II HLA antigens only, and 7 (29.2%) to both class I and class II HLA antigens. There was a trend towards inferior overall actuarial pancreas graft survival (63.7% ) for patients that developed dnDSA compared to those that did not (89.1%), however it did not reach statistical significance, p=0.181. In a univariate analysis only female recipient gender (HR 3.37, 1.31-8.70, p=0.01), and PRA≥30 (HR 2.73, 1.03 – 7.21, p=0.04) were associated with the development of dnDSA post pancreas transplant. Other recipient and donor factors were not found to be significant including degree of HLA mismatch, transplant type (SPK vs PTA), induction immunosuppression, and previous biopsy proven rejection episodes.
Conclusion: De novo DSA was associated with a clinically significant but statistically insignificant inferior pancreas graft survival. The majority of dnDSA was generated to class II HLA antigens. Female recipient gender and PRA≥30 were associated with the development of dnDSA. Better strategies to prevent dnDSA, especially in sensitized female recipients may improve graft outcomes.
15:30 - 17:00
|Pancreas & Islet Donors: Assessing Risk and Optimizing Outcomes||The Survival Benefit of Donation After Cardiac Death Simultaneous Pancreas-Kidney Transplantation in Type 1 Diabetics||Room 110|
15:30 - 17:00
|Pancreas and Islet Transplantation: Antibodies, Immunosuppression, and Outcomes||Incidence, Outcomes and Predictors of de novo Donor Specific Antibody in Pancreas Transplantation||Room 110|