P006 : SUCCESSFUL RENAL TRANSPLANTATION OF HIV+ PATIENTS WITH T CELL REACTIVE ANTIBODIES AND POSITIVE T CELL CROSSMATCH

Abstract

Antibody dysregulation associated with HIV infection poses unique challenges in assessing histocompatibility of HIV+ transplant candidates with organ donors. Interpretation of crossmatch results is often difficult and may lead to unnecessary denial of transplantation. In this study, we analyzed pre-transplant crossmatch results in relation to post-transplant outcome in 7 HIV+ renal allograft recipients. During May 1, 2009 to Aug 1, 2013, 7 out of 373 patients who received renal transplantation at our institution were HIV positive. At the time of transplantation, all 7 patients were on HAART therapy, with undetectable viral load and CD4+ T cell counts higher than 200 cells/μl. Anti-HLA antibody testing was performed using the Single Antigen Bead (SAB) assay. Crossmatch (XM) was performed using flow cytometry (FC) and complement dependent cytotoxicity (CDC). Five out of 7 HIV+ patients were previously sensitized to HLA antigens (cPRA > 10%). Two patients had low strength DSA (MFI N = 5) received either Simulect or Thymoglobulin induction, while patients with DSA ( N = 2) received Thymoglobulin and IVIG. All patients received standard maintenance immunosuppression. At one year post-transplantation, the DSA found before transplant were undetectable. De novo DSA directed to donor DQ antigens developed in two patients. None of the patients experienced allograft rejection during the follow-up interval. Graft and patient survival was 100%. No. patients with pre-tx DSA (MFI 2/7 No. positive donor T cell FCXM 4/7 No. positive auto T cell FCXM 4/7 No. positive donor B cell FCXM 0/7 No. positive auto B cell FCXM 0/7 No. patients with de novo DSA at 1 year (MFI > 3000) 2/7 Median follow-up interval, months 21 Serum creatinine, mg/dl 1.4 Graft survival 7/7 Patient survival 7/7 Conclusion We report here that successful transplantation of HIV+ patients against a positive T cell FCXM caused by T cell reactive autoantibodies can be achieved. Pre-transplant DSA and auto-crossmatch results have to be considered in the interpretation of donor crossmatch results in HIV+ patients.