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Pretransplant serum sCD30: Impact on graft outcome after kidney transplantation
S94
Abstracts
1.3 152-P
PRETRANSPLANT SERUM sCD30: IMPACT ON GRAFT OUTCOME AFTER KIDNEY TRANSPLANTATION Yehia Awadalla,1 Medhat Askar,1 Kris Ruppert,2 Jake Demetris,1 Parmjeet Randhawa,1 Ron Shapiro,3 Adriana Zeevi,1 Rene Duquesnoy1, 1Pathology, University of Pittsburgh, Pittsburgh, PA, USA; 2Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA; 3Surgery, University of Pittsburgh, Pittsburgh, PA, USA CD30 is expressed on activated T and B cells.We used an ELISA assay to measure sCD30 levels in pretransplant sera from 55 patients who received kidney grafts from deceased donors. All but one patient were non-sensitized (PRA ⬍10%), all were cross match negative by AHG -CDC; all received the same induction, initial and maintenance immunosuppression. Data were retrieved and the results were statistically analyzed. It showed that, the average sCD30 level in the patients who suffered any number of ACR (1-3, N. ⫽ 20) was 87.2 u/ ml compared to 98.3 u/ml in non rejecters (P ⫽ .46). During the first year posttransplantion, one graft was lost due to primary non function and eight were lost to rejection. The average sCD30 was 79.8 u/ml in those patients who lost their grafts compared to 95.4 u/ml in those who maintained functioning grafts (P ⫽ .63). In patients with a sCD30 ⬎100u/ml, the incidence of ACR were 31.6% (6/19), graft failure was seen in 15.8 % ( 3/19), the average serum creatinine over the first 13 weeks was (1.7 ⫾ 0.7), and the incidence of BK virus nephropathy in 5.3% (1/19). In patients with a sCD30 ⬍100 u/ml, the interest of ACR was 40% (P ⫽ .39), graft failure was seen in 14.3% (P ⫽.81), the average serum creatinine was 1.9 ⫾ 0.7 (P ⫽ .48) and BK virus nephropathy was observed in 5.7% (2/35). While the number of patients who suffered graft failure in this study is small to support a strong conclusion, these results show that pretransplant serum level of sCD30 is non predictive of kidney graft outcome in the first year after transplantation.
1.3 153-P
DONOR SPECIFIC ANTIBODY (DSA) DETECTION BY LABSCREEN BEADS, BASED ON MESF, CORRELATES WITH C4d/BIOPSY PROVEN HUMORAL REJECTION Tiffany E. Kaiser,1 Brian Susskind,2 Prabir Roy-chaudhury,1 Michael Cardi,3 Lois Arend,1 Shaoming Huang,3 Gautham Mogilishetty,1 Adele Rike,1 E.S. Woodle4, 1Internal Medicine, U Cincinnati, Cincinnati, OH, USA; 2Transplantation Immunology, Hoxworth Blood Center, Cincinnati, OH, USA; 3Nephrology, Christ Hospital, Cincinnati, OH, USA; 4Surgery, U Cincinnati, Cincinnati, OH, USA Objective: To determine correlation among DSA, renal allograft pathology and C4d deposition. Methods: 39 patients with suspected rejection underwent 42 biopsies (Bx). DSA at the time of Bx was analyzed by Luminex using LabscreenTM HLA beads (One Lambda). Fluorescence values were converted to MESF using QuantumTM microbeads standard curves (Bangs Labs). Cut-off values were 3x autologous HLA antigens’ MESF. Results: (Fig.1) 26/42 (62%) had Bx proven rejection (BPR) based on Banff97 criteria for cellular and/or antibody mediated rejection; 11/26 BPR (42%) were C4d positive. Correlation of DSA with C4d was excellent (p⬍0.001, Sensitivity ⫽ 91%, Specificity ⫽ 93%). However, DSA class (anti-I (27%), anti-II (64%) or both (9%)) and titer (median ⫽ 178,000 MESF (36,000-935,000)) did not correlate with Banff grade or cellular AR. Conclusions: Identification of DSA with LabScreen antigen beads by MESF criteria strongly predicted C4d positivity in BPR. Although DSA/C4d correlation was independent of specificity (class I/II) or MESF level, humoral rejection was highly associated with anti-HLA Ab deposition and complement activation.
Abstracts
1.3 152-P
PRETRANSPLANT SERUM sCD30: IMPACT ON GRAFT OUTCOME AFTER KIDNEY TRANSPLANTATION Yehia Awadalla,1 Medhat Askar,1 Kris Ruppert,2 Jake Demetris,1 Parmjeet Randhawa,1 Ron Shapiro,3 Adriana Zeevi,1 Rene Duquesnoy1, 1Pathology, University of Pittsburgh, Pittsburgh, PA, USA; 2Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA; 3Surgery, University of Pittsburgh, Pittsburgh, PA, USA CD30 is expressed on activated T and B cells.We used an ELISA assay to measure sCD30 levels in pretransplant sera from 55 patients who received kidney grafts from deceased donors. All but one patient were non-sensitized (PRA ⬍10%), all were cross match negative by AHG -CDC; all received the same induction, initial and maintenance immunosuppression. Data were retrieved and the results were statistically analyzed. It showed that, the average sCD30 level in the patients who suffered any number of ACR (1-3, N. ⫽ 20) was 87.2 u/ ml compared to 98.3 u/ml in non rejecters (P ⫽ .46). During the first year posttransplantion, one graft was lost due to primary non function and eight were lost to rejection. The average sCD30 was 79.8 u/ml in those patients who lost their grafts compared to 95.4 u/ml in those who maintained functioning grafts (P ⫽ .63). In patients with a sCD30 ⬎100u/ml, the incidence of ACR were 31.6% (6/19), graft failure was seen in 15.8 % ( 3/19), the average serum creatinine over the first 13 weeks was (1.7 ⫾ 0.7), and the incidence of BK virus nephropathy in 5.3% (1/19). In patients with a sCD30 ⬍100 u/ml, the interest of ACR was 40% (P ⫽ .39), graft failure was seen in 14.3% (P ⫽.81), the average serum creatinine was 1.9 ⫾ 0.7 (P ⫽ .48) and BK virus nephropathy was observed in 5.7% (2/35). While the number of patients who suffered graft failure in this study is small to support a strong conclusion, these results show that pretransplant serum level of sCD30 is non predictive of kidney graft outcome in the first year after transplantation.
1.3 153-P
DONOR SPECIFIC ANTIBODY (DSA) DETECTION BY LABSCREEN BEADS, BASED ON MESF, CORRELATES WITH C4d/BIOPSY PROVEN HUMORAL REJECTION Tiffany E. Kaiser,1 Brian Susskind,2 Prabir Roy-chaudhury,1 Michael Cardi,3 Lois Arend,1 Shaoming Huang,3 Gautham Mogilishetty,1 Adele Rike,1 E.S. Woodle4, 1Internal Medicine, U Cincinnati, Cincinnati, OH, USA; 2Transplantation Immunology, Hoxworth Blood Center, Cincinnati, OH, USA; 3Nephrology, Christ Hospital, Cincinnati, OH, USA; 4Surgery, U Cincinnati, Cincinnati, OH, USA Objective: To determine correlation among DSA, renal allograft pathology and C4d deposition. Methods: 39 patients with suspected rejection underwent 42 biopsies (Bx). DSA at the time of Bx was analyzed by Luminex using LabscreenTM HLA beads (One Lambda). Fluorescence values were converted to MESF using QuantumTM microbeads standard curves (Bangs Labs). Cut-off values were 3x autologous HLA antigens’ MESF. Results: (Fig.1) 26/42 (62%) had Bx proven rejection (BPR) based on Banff97 criteria for cellular and/or antibody mediated rejection; 11/26 BPR (42%) were C4d positive. Correlation of DSA with C4d was excellent (p⬍0.001, Sensitivity ⫽ 91%, Specificity ⫽ 93%). However, DSA class (anti-I (27%), anti-II (64%) or both (9%)) and titer (median ⫽ 178,000 MESF (36,000-935,000)) did not correlate with Banff grade or cellular AR. Conclusions: Identification of DSA with LabScreen antigen beads by MESF criteria strongly predicted C4d positivity in BPR. Although DSA/C4d correlation was independent of specificity (class I/II) or MESF level, humoral rejection was highly associated with anti-HLA Ab deposition and complement activation.