Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Outcomes of Pancreas Transplant Recipients With De Novo Donor-specific Antibodies

Parajuli, Sandesh, MBBS1; Alagusundaramoorthy, Sayee, MD1; Aziz, Fahad, MD1; Garg, Neetika, MD1; Redfield, Robert R., MD2; Sollinger, Hans, MD, PhD2; Kaufman, Dixon, MD, PhD2; Djamali, Arjang, MD1,2; Odorico, Jon, MD2; Mandelbrot, Didier, MD1

doi: 10.1097/TP.0000000000002339
Original Clinical Science—General

Background Development of de novo donor-specific antibodies (dnDSA) has detrimental effects on graft survival in several types of solid organ transplants. However, limited information exists about the effect of dnDSA on pancreas transplant graft survival.

Methods We report our experience with pancreas recipients transplanted between January 01, 2005, and August 31, 2017.

Results We identified 541 pancreas transplant recipients, of which 121 developed dnDSA and 420 did not. Thirty-two percent developed dnDSA against HLA class I antigens, 56% developed against class II antigens, and 12% developed against both. Fifty-two percent of the patients in the dnDSA+ and 24% in the dnDSA− group underwent pancreas biopsy, mainly due to a rise in pancreatic enzymes. Rejection was found in 42% of the dnDSA+ group, and 20% of the dnDSA− group(P < 0.001). There were 36% uncensored graft failures in the dnDSA+ group and 17% uncensored failures in the dnDSA− group (P < 0.001). A similar trend was seen in death-censored graft failure between the groups. In univariate Cox regression analyses, male sex, older age, and recipients of simultaneous pancreas and kidney transplant were found to be protective for death-censored graft failure; multiple transplants, dnDSA, requirement for pancreas biopsy and presence of pancreas rejection were associated with increased risk of graft failure. In multivariate analysis, only older age and dnDSA were significantly associated with death-censored graft failure.

Conclusions Our findings suggest that dnDSA in pancreas transplant recipients are associated with increased rates of rejection and graft failure. Timely detection of dnDSA through regular screening and early treatment of pancreas rejection may ultimately improve graft outcomes.

Using a cohort of 541 pancreas transplant recipients, the authors report that, like in other organ transplant recipients, de novo donor-specific antibodies i are associated with increased rates of rejection and graft failure.

1 Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.

2 Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Received 4 April 2018. Revision received 27 May 2018.

Accepted 14 June 2018.

The authors have no financial disclosures.

This work was supported by an unrestricted research grant from the Virginia Lee Cook Foundation.

S.P. participated in the concept, design, data collection, analysis, article preparation, editing. S.A. participated in the data collection, analysis, article preparation, and editing. F.A. participated in the data collection, analysis, article preparation, and editing. N.G. participated in the data collection, analysis, article preparation, and editing. R.R.R. participated in the analysis, article preparation, and editing. H.S. participated in the analysis, article preparation, and editing. D.K. participated in the analysis, article preparation, and editing. A.D. participated in the analysis, article preparation, and editing. J.O. participated in the concept, design, analysis, article preparation, and editing. D.M. participated in the concept, design, analysis, article preparation, and editing.

D.M. and J.O. contributed equally to this study.

Correspondence: Sandesh Parajuli, MBBS, UW Medical Foundation Centennial Building 4175, 1685 Highland Avenue, Madison, WI 53705. (sparajuli@medicine.wisc.edu).

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.