Long-Term Outcomes of Renal Transplant Allografts With De Novo DSA in the Setting of Stable Function

We sought to determine the long-term outcomes of renal allografts that developed de novo DSA (dnDSA) in the setting of stable function.

This retrospective single-center review of renal allograft recipients transplanted between January 2008 and December 2011. DnDSA testing was performed at 3, 6, 9, and 12 months and yearly thereafter.

The study included 501 recipients; 84% primary transplants, and 37% living donors. The median follow-up duration was 110 (range 9-157) months. One hundred fifty-seven (31%) recipients developed dnDSA, and the median time to the first dnDSA was 18 (range 3-144) months. Death-censured graft survival in recipients with no DSA was significantly better than that of dnDSA-positive recipients. There were 344 recipients with no DSA (group 1), 117 recipients with dnDSA and stable graft function (group 2), and 40 recipients with dnDSA-associated acute rejection (group 3). Death-censured graft survival was equivalent between groups 1 and 2 and significantly better than that in group 3. Seventy-eight percent of Group 3 lost their grafts at a median of 56 (range 12-137) months posttransplant. Group 2 recipients had an increased incidence of late acute rejection compared to group 1 (p < 0.001), yet the mean eGFR values of both groups were equivalent at one, 5, and, 10 years posttransplantation (p > 0.05).

Development of dnDSA in recipients with stable graft function increased the risk of late acute rejection, but had no detrimental impact on long-term graft survival or function. De novo DSA, associated with acute rejection, generally resulted in long-term graft loss.