Slide 1

The Importance of HLA-DP Typing and Matching

Ty Dunn, Harriet Noreen, David Maurer, Abhi Humar, Raja Kandaswamy, David Sutherland, William Payne, and Arthur Matas
Department of Surgery, University of Minnesota, Minneapolis, MN

Body

Results

Results

Whether or not HLA-DP typing and matching is important is controversial. With single antigen bead testing, we can now assess transplant (Tx) recipients with isolated anti-DP donor specific antibody (DSA) (in the absence of any other DSA) for increased risk of antibody mediated rejection (AMR).

MM

B XM

DSA at Tx

MFI at Tx

Rej (day #)

Best Cr

Current Cr

GS (mo)

2

QNS

DP3

1225

-

1.1

1.5

44

2

Neg

DP17

3827

-

1.0

1.2

35

0

QNS

DP1

7687

-

2.2

2.2

25

Patients & Methods

Table 1. Living Donor Recipients. MM = # antigen mismatches, QNS: quantity not sufficient, MFI: mean fluorescence index, Rej: rejection, Cr: creatinine (mg/dl), PNF: primary non-function, DWF: death with function, GS: graft survival (months)

Pre-Tx sera was screened for anti-DP antibody for 645 kidney transplant (Tx) recipients. LD Tx was done if -T and -B CDC-AHG XM. DD Tx was done if -T XM; B XM was done retrospectively if any Class II PRA, and donor DP typing was done if the recipient had antibody against DP. All recipients had Thymoglobulin induction with CNI and MMF maintenance immunosuppression. Outcomes were examined.

MM

B XM

DSA at Tx

MFI at Tx

Rej (day #)

Best Cr

Current Cr

GS (mo)

6

Neg

Effect of a Preemptive PP/IVIG Induction Protocol on Kidney Transplants with Donor Specific Antibody

DP

533

-

0.7

1.0

52

4

Neg

DP3

559

-

0.9

1.1

12

0

Neg

100.0%

90.0%

DP3

1044

-

1.2

1.4

19

0

Neg

80.0%

70.0%

DP0301

5574

-

PNF

Failed – thrombosis

0

0

QNS

60.0%

DP0501

1187

Percentages

50.0%

40.0%

DP3

8129

-

1.2

Failed – DWF

35

0

1:4

DP3

7869

ACR 1A (172)

1.0

1.9

43

12 patients were found to have DSA to DP and to no other Class I or II HLA. 11 (92%) were retransplants. 9 (75%) were DD grafts. 8 (67%) received 0 MM grafts. All 12 had T XM, and 3 (25%) had +B XM. Patient characteristics and outcomes are shown in Table 1 (LD recips) and Table 2 (DD recips).

Three (25%) had AMR without acute cellular rejection (ACR); each having multiple/continuous episodes of AMR during the first 90 days post-Tx and requiring aggressive treatment for graft salvage. One such graft failed 9 months after Tx. Another possessed DPA, and is the first case associated with AMR. One additional graft was lost to thrombosis on day 6, but no technical cause was found. Only 1 (8%) patient had ACR.

30.0%

0

Neg

20.0%

10.0%

DP2

2744

AMR x3 (12)

1.6

1.6

12

0

>1:16

DP17

11277

AMR x4 (12)

1.1

Failed – acute rej

9

Conclusion

UNIVERSITY OF MINNESOTA

MEDICAL CENTER

0

1:128

DPA0103

7707

AMR x3 (7)

0.9

1.45

4

FAIRVIEW

Table 2. Deceased Donor Recipients. MM = # antigen mismatches, QNS: quantity not sufficient, MFI: mean fluorescence index, Rej: rejection, Cr: creatinine (mg/dl), PNF: primary non-function, DWF: death with function, GS: graft survival (months)

DSA solely to HLA-DP is associated with +B cell XM, AMR, and graft loss. Routine DP locus HLA donor typing and determination of recipient DP DSA could help avoid the risk of AMR and graft loss.

© Department of Surgery, University of Minnesota