52-P: DE NOVO DEVELOPMENT OF DONOR SPECIFIC HLA ANTIBODIES IS STRONGLY ASSOCIATED WITH ANTIBODY MEDIATED REJECTION FOLLOWING LIVE DONOR RENAL TRANSPLANTATION

Abstract

The harmful effects of preformed and de novo development of donor specific anti HLA antibodies in solid organ transplantation have been extensively reviewed and are found to be associated with allograft dysfunction. The spectrum of antibody mediated insult ranges from hyperacute rejection to chronic antibody mediated rejection (AMR) leading ultimately to graft loss. With the advent of solid phase assays, the sensitivity and specificity of antibody detection have increased. We studied 105 renal transplant recipients who had undergone live donor renal transplantation at this hospital. None of the recipients were sensitized. The recipients were longitudinally followed-up for a period of 60 months after transplantation. Serum samples collected serially at pre-transplant, at least one time during the post-transplant period and at the time of rejection were analyzed by the solid-phase immunoassay system on a Luminex 200 Platform using OneLambda SAB kits. Of the total patients, 79 did not show any evidence of AMR. The remaining 26 (24.7%) recipients had evidence of AMR as characterized by donor specific antibodies, histopathological changes and C4D staining on biopsy as per the Banff 2007 criteria. Luminex SAB analysis revealed that out of the 26 patients experiencing AMR, 80.7% had DSA compared to recipients who had no evidence of AMR (12.6%). The study highlights the relevance of de novo development of donor specific HLA antibodies with AMR in the renal allograft recipients.