Donor-Specific Antibodies in the Steroid-Free Renal Transplant Population

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Scientific Poster Presentations: 2017 Clinical Congress

CONCLUSIONS: This single-center study associates cannabis use with established risk factors for poor outcomes after solid organ transplant. Despite the current trend of legalization of cannabis, its use in this population deserves caution in both pre- and posttransplant settings. This study serves as a starting point for developing evidence-based policies regarding cannabis use in organ transplantation. Does Increase in BMI Provide a Survival Benefit after Lung Transplantation? A Propensity Score Analysis of the United Network for Organ Sharing Registry Asishana A Osho, MD, MPH, Uduak Ekanem, Marcelo Fernandes, MD, MPH, Philip J Spencer, MD, Jordan P Bloom, MD, Andrea Axtell, MD, Sameer A Hirji, MD, Matthew G Hartwig, MD, FACS, Mauricio Villavicencio, MD Harvard Medical School, Boston, MA; Duke University School of Medicine, Durham, NC; University of Miami School of Medicine, Miami, FL INTRODUCTION: Increased BMI has been associated with worse outcomes in lung transplantation; however, recent data suggests a survival benefit for overweight recipients, particularly in the setting of poor functional status. The purpose of this study is to explore the BMI-mortality relationship in lung transplantation. We hypothesized that after rigorous risk-matching, obese and overweight recipients would have equivalent or superior survival compared with normal BMI recipients. METHODS: Data from primary, lung transplantations performed in the US from 1987 to 2015, were analyzed from the United Network for Organ Sharing (UNOS) registry. Propensity scores were used to risk-match obese and overweight recipients with normal BMI recipients based on multiple risk factors including functional status. Kaplan-Meier and Cox regression models compared survival between matched groups. RESULTS: A total of 27,363 lung recipients met inclusion criteria with 9,110 (33.3%) classified as overweight (2530) at transplantation. Seven thousand fifty-seven overweight and 3,584 obese recipients were risk-matched 1:1 with normal BMI (18.5
J Am Coll Surg

Donor-Specific Antibodies in the Steroid-Free Renal Transplant Population Ryan J Schutt, DO, Jamie Case, PhD, Bethany Barrick, Ann M Harper, MPH, Michael Quigley, MD, Jonathan S Fisher, MD, FACS, Randolph L Schaffer III, MD, FACS, Christopher L Marsh, MD, FACS Scripps Green-Dept of Organ Transplant, San Diego, CA INTRODUCTION: Renal transplant recipients with donor specific antibodies (DSA) have been shown to have higher rates of rejection and graft loss. Outcomes in the steroid free population have been poorly studied. We evaluated risk factors and outcomes in the steroid-free renal transplant population with DSA. METHODS: A retrospective analysis of steroid-free renal allograft recipients at this institution from 2010-2016 was performed. Recipients with and without donor specific antibodies were compared. Cohorts included no DSA (non-DSA), pre-existing DSA and de novo DSA (dnDSA). Primary outcomes included risk of rejection and graft survival rates. Secondary outcomes included DSA against specific HLA loci associated with rejection. RESULTS: Statistical analysis identified 226 renal allograft recipients. Fifty-six patients had DSA, while 170 were non-DSA. The majority of DSA patients developed dnDSA (n¼36). Hypertension was the most common cause of renal failure in dnDSA and nonDSA, while IgA nephropathy was most common in the pre-existing cohort. HLA mismatch and type of donor were not significant for dnDSA formation. Anti HLA-DQ and eDR were the most common dnDSA (41.7%) and pre-existing DSA (35%) respectively. DSA was associated with rejection (p¼0.0002), specifically anti HLA-DR dnDSA (p¼0.02). There was no relationship with graft loss, and 2-year graft survival was greater than 90% in all groups. CONCLUSIONS: This single center retrospective analysis in the steroid-free renal transplant population with DSA similarly correlates with a higher risk of rejection as seen in the literature. Despite no association with graft loss in our study, vigilance for DSA is advisable. Eliminating Central Line Associated Blood Stream Infections in a High Acuity Liver Transplant Intensive Care Unit Tara A Russell, MD, MPH, Elyse Fritschel, MPH, Jennifer Do, Melanie Donovan, Mo Keckeisen, Vatche G Agopian, MD, FACS, Douglas F Farmer, MD, Zachary A Rubin, MD, Ronald W Busuttil, MD, PhD, FACS, Fady M Kaldas, MD, FACS Scripps Green-Dept of Organ Transplant, San Diego, CA; United Network for Organ Sharing-Department of Data Analytics, Richmond, VA INTRODUCTION: Dramatic increases in perioperative acuity have rendered frail, immunosuppressed liver transplant patients at elevated risk for nosocomial infections. Avoiding central line associated blood stream infections (CLABSI) is paramount to facilitate