Influence of Post Transplant De Novo Anti-MHC Antibody On The Outcomes After Simultaneous Kidney and Pancreas Transplantation.

Abstract

We evaluated the influence of development of post transplant de novo anti-MHC antibodies on the outcomes after simultaneous kidney and pancreas transplantation. Since 1/1/2002, 285 patients underwent primary simultaneous kidney and pancreas transplantations at our center. Of these patients, 90 developed de novo anti-MHC class I or class II antibodies (30 were DSA by Luminex single bead analyses). 174 patients were tested and remained negative for post transplant anti-MHC antibodies. The remaining 21 patients were not tested and were excluded from this study. We compared the outcomes between the antibody positive and negative groups regarding: acute rejection, kidney and pancreas graft survivals using Kaplan-Meier survival curve analysis as well as Cox proportional hazard model regression analyses. Results: There were no significant differences between groups in regards to age or sex of the recipients however; there were significantly (p<0.01) more African Americans in the antibody positive group (19 out of 90, 21.1%) than in the antibody negative group (17 out of the 174, 9.8%). The antibody positive group had significantly a higher incidence of acute rejection, and a lower 1, 3 and 5 year death censored kidney and pancreas graft survivals when compared to the antibody negative group (table). Multivariate analysis identifies anti MHC antibody (hazard ratio HR: 4.1, 95% CI 2.2-4.7) and acute rejection (HR 2.8, 95% CI 1.5-5.2) as significant risk factors for kidney graft loss. For the pancreas, only anti-MHC antibodies were significant risk factor for graft loss (HR 2.3, 95% CI 1.3-4.3. We conclude that post transplant de novo anti MHC antibodies are associated with worse outcomes after simultaneous kidney and pancreas transplantation.Table: No Caption available.