title: Early immunosuppression treatment correlates with later de novo donor-specific antibody development after kidney and pancreas transplantation.
abstract: BACKGROUND
  De novo donor-specific antibodies (dnDSA) post-transplant correlate with a higher risk of immunologic graft injury and loss following kidney and pancreas transplantation. Post-transplant dnDSA can occur within the first post-transplant year.
  
  
  METHODS
  In this study, 817 of 1290 kidney and simultaneous kidney/pancreas recipients were tested for dnDSA post-transplant. Recipient immunosuppressive treatment at one, three, six, and 12 months post-transplant was correlated with dnDSA incidence by univariate and multivariate analyses.
  
  
  RESULTS
  The overall incidence of dnDSA was 21.3% detected a median of 3.5 yr post-transplant. By univariate analysis, the immunosuppressive treatment at all time points correlated with dnDSA (p < 0.01). Month 6 treatment correlated best in multivariable analysis (p = 0.004). At six months, recipients receiving rapamune/mycophenolic acid (Rapa/MPA) had the highest dnDSA incidence at five yr (25.3%) and last follow-up (30.7%), those treated with cyclosporine/rapamune (CNI/Rapa) had the lowest incidence at five yr (10.8%) and last follow-up (18.6%), and cyclosporine/mycophenolic acid (CNI/MPA) treatment had an intermediate incidence at five yr (16.7%) and last follow-up (20.4%) (p < 0.01). Six-month CNI/MPA and Rapa/MPA treatment significantly correlated with dnDSA (hazard ratios of 2.36 and 1.80, respectively) by Cox proportional hazards regression modeling.
  
  
  CONCLUSIONS
  The risk of post-transplant dnDSA development correlates with early immunosuppressive management.
authors.affiliation: Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Pelletier
authors.affiliation: Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Amer A
authors.initials: AA
authors.lastname: Rajab
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Diez
authors.affiliation: Tissue Typing Laboratory, The Ohio State University, Columbus, OH, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: DiPaola
authors.affiliation: Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Ginny L
authors.initials: GL
authors.lastname: Bumgardner
authors.affiliation: Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Elmahdi A
authors.initials: EA
authors.lastname: Elkhammas
authors.affiliation: Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Henry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D007518:Isoantibodies
keywords: donor-specific antibody; graft outcomes; immunosuppression; kidney transplant; survival