A rational approach to guide cost-effective de novo donor-specific antibody surveillance with tacrolimus immunosuppression

• DOI: 10.1016/j.ajt.2023.07.025
• Publication Date: 2023-08-04T07:40:09Z
• Authors: Chris Wiebe; Rob Balshaw; Ian W. Gibson; Julie Ho; Jamie Shaw; Martin Karpinski; Aaron Trachtenberg; Denise Pochinco; Aviva Goldberg; Patricia Birk; Maury Pinsk; David N. Rush; Peter W. Nickerson
• Keywords: Immunosuppression; Subclinical infection

De novo DSA (dnDSA) after renal transplantation has been shown to correlate with antibody-mediated rejection and allograft loss. However, the lack of proven interventions time cost associated annual screening for dnDSA are difficult justify all recipients. We studied a well-characterized consecutive cohort (n=949) over fifteen years prospective surveillance identify risk factors that would help institute resource-responsible strategy. Younger recipient age HLA-DR/DQ molecular mismatch were independent predictors development. Combining both into Recipient Age Molecular Mismatch (RAMM) categories we found 52% recipients could be categorized as low-risk development (median subclinical dnDSA-free survival at 5 10 98% 97%). After adjustment, multivariate correlates included tacrolimus versus cyclosporin maintenance immunosuppression (HR 0.37, 95%CI 0.2-0.6, p<0.0001), RAMM category intermediate low 2.48, 1.5-4.2, p=0.0007), high 2.56, 1.6-4.2, p=0.0002), 6.36, 3.7-10.8, p<0.00001). When combined, provide novel data-driven approach reduce testing by >50% while selecting those most likely benefit from surveillance.