The Impact of Pre-Transplant Donor Specific Antibodies (DSA) on AMR Rates in HIV Kidney Transplant Recipients Inducted with IL-2 RA

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Background1-year rejection rates in HIV-infected kidney transplant recipients range from 15-40%, compared to overall rejection rates of 10% in HIV-negative patients. We report the impact of DSA on outcomes of HIV-infected kidney transplant recipients who received IL-2RA induction therapy at our center.MethodsThis study is an IRB-approved, single center, retrospective study of adult HIV-infected patients with a kidney transplant performed between 5/2009 to 12/2014 with 3-year follow up for each patient.Results11/42 (26%) had pre-transplant donor specific antibodies (DSAs), defined as MFI > 1000 to at least one class I or class II locus. All of these patients received IVIG at the time of transplant. 8/11 (73%) patients with pre-transplant DSA had a total of 11 biopsy proven rejections (BPRs); 2/11 (18%) allografts were explanted because of rejection. 7/11 (64%) rejections were either acute or chronic AMR. 5/8 (63%) patients with pre-transplant DSA and a BPR had at least one episode of AMR.15/31 (48%) of patients without pre-transplant DSA had at least one episode of biopsy proven rejection (BPR) and a total of 13 BPRs. 12/13 (92%) rejections were acute cellular rejections. Only 1/13 (8%) patient without DSA had an AMR, which was significantly lower than the AMR incidence in the pre-transplant DSA group (p = 0.008). 1/31 (3%) allograft in this group was explanted, compared to 2/11 (18%) in the DSA group.Death censored graft survival at 3 years was 9/11 (82%) in the DSA group compared to 30/31 (97%) in those without DSA.ConclusionsThe rates of AMR and death censored graft loss in HIV-infected kidney transplant recipients induced with IL-2RA are higher in those with pre-transplant DSA. Further studies should evaluate if the presence of DSAs in this patient population warrants more aggressive induction and maintenance immunosuppressive therapy.

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