SP776IS MORE INTENSIVE INDUCTION IMMUNOSUPPRESSION THERAPY FOR HIGHLY SENSITIZED KIDNEY TRANSPLANT RECIPIENTS BETTER ?

INTRODUCTION: Induction immunosuppression for highly sensitized kidney recipients varies, in particular the use of plasma exchanges (PE) and rituximab following transplantation to prevent antibody-mediated rejection (ABMR) and increase graft survival. We compared two induction strategies for patients undergoing kidney transplantation with a high level (MFI>3000) of pre-formed donor-specific antibody (DSA). METHODS: Our retrospective study included 45 kidney transplant recipients in two French centers, transplanted between 2012 and 2017. All patients had at least one pre-formed DSA (MFI > 3000) within 6 months before transplantation. All patients received anti-thymocyte globulin, a calcineurin inhibitor, mycophenolate mofetil and steroids on the day of transplantation. 22 of these 45 patients also received 5 PE and one rituximab dose (group A), whereas the remaining 23 patients did not (group B). Patients were followed for 1 to 6 years after transplantation. RESULTS: Comparing group A to group B, recipients’ age (48±14 vs. 47±12 years), donors’ age (54±16 vs. 57±12 years), cold ischemia time (16±6 vs. 19±7 hours) and MFI of the immunodominant DSA (8735±4192 vs. 10106± 6015) were similar (p=ns for all). There was no overall difference in the rate of biopsy-proven acute rejection at 1 year post-transplantation (n=9, 41% in group A vs. n=7, 30% in group B). ABMR occurred in n=6 vs. n=7 patients, and T-cell mediated rejection was observed in n=3 vs. n=0 patients, respectively in groups A and B. There was no difference in graft survival rate at 1 year post-transplant (91% in group A vs. 83% in group B, p=ns). Finally, the incidence of infectious, anaphylactic, thrombotic or hemorrhagic events was similar between the two groups. CONCLUSIONS: Our study suggests that an intensive induction immunosuppressive therapy using PE and rituximab during early post-transplantation period does not decrease ABMR incidence or improve 1-year graft survival in highly sensitized recipients. An effect of PE on anti-thymocyte globulin pharmacokinetics could not be excluded.