Early Excellent Outcomes of Flow Cross-Match Negative Kidney Transplant Recipients With Pre-Formed IgG DSA, C1q Negative With or Without Peri-Operative IVIg Infusion.

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It is not clear if patients with a negative cross-match but with DSA need additional therapy at the time of transplant to prevent an amnestic reaction that could lead to early AMR. Based on our experience with a high dose IVIg desensitization program, we have conducted a stepwise deletion of peri-operative IVIg according to the DSA MFI. Intervention: All patients received ATG induction and triple therapy maintenance immunosuppression with tac, MMF and steroids. All patients were T and B flow cross-match compatible. The first 10 pts had at least one current DSA with a MFI > 1000. They received IVIg 2G/Kg at the time of Tx and 3 weeks later. The threshold to received IVIg was increased to 1500 MFI for the next 10 pts and subsequently to 2000 MFI (3 pts thus far). All patients were monitored post Tx for DSA with single antigen bead immunoassay for IgG and C1q. We compared the outcomes at 1 year of pts who received the IVIg and those who didn't according to the titration scheme. Results: From 4/08 to 9/13, thirty-two patients were treated according to this protocol. Twenty three patients with DSA MFI > 1000 received IVIg (group1) and 9 patients with MFI < 2000 did not receive IVIg (group2). Patient and graft survival were 100% at 1 year in both groups. Only one graft was lost in group 1, five years post-Tx after 2 years lost to follow-up. There were no episodes of cellular or humoral rejection in either group. Of group 1, 16/23 became DSA negative post Tx at least for 1 year, 6 remained DSA IgG positive and 1 intermittently became DSA IgG and C1q positive. In group 2: 8/9 became DSA negative, one pt remained DSA IgG. The 1-year creatinine was 1.37 ± 0.49 for group1 (n=20) and 1.06 ± 0.33 (n=9) for group 2. In conclusion, recipients of kidney transplant with negative flow cross-match but with IgG DSA up to MFI of 1500 may not need peri-operative IVIg to prevent early AMR. We are currently pursuing our evaluation with increasing MFI cut off. DISCLOSURES:Tyan, D.: Other, One Lambda, licensed product.