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Beyond evidence that men and women differ in both their self-reported and objective navigation strategies and abilities, there are few studies acknowledging the potential influence of hormonal milieu across the menstrual cycle on these factors. Therefore, we will measure self-reported navigation strategy and objective navigation-related task performance involving topographic spatial memory, cognitive map use, and path/location integration between sexes and during various menstrual phases to determine how hormonal milieu may influence important navigation-related factors.

Purpose: To investigate which risk factor affects the development dnDSA.Methods: 315 patients (pts) with available antibodies study and follow upgreater then 6 months (who un derwent KTx from January 2005 to December2017) are object of our study. Mean recipients age was 52 years (range 24-71), mean donors age was 50 years (range 15-81). Mean follow up post KTxwas 59 months (range 10-60).Post transplant sera were studied at months 3 and then yearly, (or by clinicalneeds) to access the presence of dnDSA. Screening was obtained with class Iand II Flow PRA test, in positive sera class I and II Luminex single antigenbeads was performed.Patients were divided in groups depending of immunosuppressive protocol:tacrolimus and mycophenolic acid (MPA) (n = 153), cyclosporine (CsA) andMPA (n = 37), CsA and Proliferation Signal Inhibitor (PSI) (sirolimus oreverolimus) (n = 99), PSI and MPA (n = 18), other (n = 8).Development of dnDSA was correlated with known risk factors : pretransplant class I and II PRA, donors age, recipients age, immunosuppressiveprotocols.Lastly 10 years graft survival and renal function (assessed by creatinine)was compared for pts with and without dnDSA.Results: In our study 59 patients (19%) developed dnDSA after a mean timeof 32 months (range 1-136) since KTx.Immunosuppressive protocols showed similar incidence of dnDSA:tacrolimus+MPA = 26 pts (17%), CsA+MPA = 10 pts (27%), CsA+PSI = 17pts (17.2%), PSI+MPA = 6 pts (33%). (p=ns).Ten years graft survival was adversely influenced by dnDSA (78.0% vs.90.7%) (p = 0.017).Median last serum creatinine level was higher in patients with dnDSApositivity (2.0 vs. 1.5 mg/dl) (p = 0.045).Among all the variables examinated, dnDSA is positively influenced only byrecipients age: patients under 50 years of age more prone to develop dnDSA(p = 0.013).Conclusion: In our experience the only variable influencing development ofdnDSA is the recipient age minor of 50 years.

In kidney transplantation, current HLA class II matching strategies consider DR antigens only. Both a and b chains of HLA-DQ and -DP heterodimers are polymorphic and can elicit a humoral immune response. Preformed HLA class II donor-speci.c antibodies (DSA) have a deleterious impact on graft outcome and post-transplant development of anti-class II DSA is strongly associated with acute and chronic rejection occurrence. This study was done to investigate the incidence of anti-DQ and -DP antibod­ies in 56 kidney transplant (KTx) recipients who developed HLA class II DSA and 145 HLA class II-positive re-transplant candidates. Antibody characteriza­tion was performed by using Single antigen bead assay (microbeads coated with 29 DQA1/DQB1, 24 DPA1/DPB1 heterodimers besides DRB1/3/4/5, molecules). In the KTx group of patients, incidence of anti-DQ/DP DSA was signi.cantly higher than anti-DR DSA (76% vs. 20%, P < 0.0001); in 3 patients we only found anti-DQA1 DSA. During the follow up period, graft failure occurred in 14 of the 38 (36.8%) patients who only developed anti-DQ and/or -DP DSA. Analyzing speci.city of HLA class II antibodies detected in re-transplant can­didates, 131 of the 145 (90%) patients showed production of anti-DQ and/or anti-DP antibodies. Nineteen percent of these patients had only anti-DQ a/b chain antibodies, 5% had only anti-DP a/b chain antibodies and 7% had both anti-DQ and anti-DP antibodies. It is important to underline that 87% of anti- Histocompatibility DQA1/DQB1 positive patients and 98% of anti-DPA1/DPB1 positive patients developed wide antibody patterns due to the recognition of a "public epitope" of the mismatched donor molecule/s. These data demonstrate the great immunogenicity of mismatched DQA1/DQB1 and DPA1/DPB1 molecules of a kidney transplant and underline the need to consider all the HLA class II molecules in matching strategies especially for re-transplant candidates.

Background: To avoid Calcineurin Inhibitor (CI) nephrotoxicity, a CI-freeprotocol was introduced in our centre, as immunosuppressive therapy (IT) indual kidney transplantation (DKT) from marginal donors.Methods: Donor kidneys were histologically evaluated according to Remuzziscore (J Am Soc Nephrol 1999). Fifteen DKT were performed since February2009 with the following IT: basiliximab, steroids, mycophenolate sodium(1440 mg/die), sirolimus (n = 12) or everolimus (n = 3). Mean age of recipientswas 66 years (range 61-71) whereas mean donors age was 68.5 years (range55-78). All patients were analyzed for donor specific HLA-antibodies (HLA-DSA) by solid phase Luminex Single Antigen bead assay, at 1 and 6 monthsfrom KT and then yearly.Results: Median follow up was 35.7 months (range 1-73). Cumulativeincidence of acute rejection (AR) was 33.3% (5/15). ARs were biopsy proven,within 90 postoperative days and responsive to steroids treatment. The mediancreatinine at last follow-up was 1.5 mg/dl (range 0.8-2.8). Steroids werestopped in 7 recipients due to new onset diabetes. No deaths or graft lossesoccurred throughout the follow-up. No patient developed HLA-DSA throughoutthe follow-up.Discussion/Conclusions: AR episodes occurred when recipients wereunder-immunosuppressed for IT adverse events: sirolimus/everolimus bloodlevel under 5 ng/ml (n = 3), early steroid withdrawal (n = 1), or during acutetubular necrosis (n = 1). In our experience CI free IT provides good results inDKT, with excellent long term graft function. Special care should be taken insuch aged recipients with several comorbidity factors. Dual KT is oftenperformed with low HLA compatibility and adequate IT should be constantlyachieved. Hence we recommend sirolimus/everolimus trough levels on the highside of their therapeutic range in the first 6 months post KT.

Background: The once-daily (QD) formulation of tacrolimus (Tac) showedsimilar efficacy than twice-daily (BD) Tac and seems to improve adherence inkidney transplant (KT) recipients. The aim of our study was to define theefficacy and the safety of "de novo" QD Tac administration in KT recipients whoshowed pre KT high panel reactive antibodies (PRA).Methods: Twentyeight patients with a median PRA of 88.3%(range 64-100)who underwent KT were enrolled in the study. Patients were transplanted with anegative crossmatch performed using both cytotoxic and flow-cytom etricmethods. All patients received following immunosuppress ion: basiliximab,steroids, QD-Tac based at 0.2 mg/kg to reach a trough levels of 7-10 ng/mL;27 patients received mycophenolate and one everolimus also. All patients wereanalyzed for donor specific HLA-antibodies (HLA-DSA) by solid phase LuminexSingle Antigen bead assay, at 1 and 6 months from KT and then yearly.Results: Median follow-up was 26.4 months (range 2-57). The 3 yearspatients and graft survival were 100%. The median creatinine at last follow-upwas 1.5 mg/dl (range 0.9-3.1); no patients showed proteinuria. One patientexperienced acute rejection (category 4 IIA Banff '07) at POD 9; after steroidsbolus he was switched to BD Tac because the difficulties to achieve atherapeutic Tac level. No patient developed HLA-DSA throughout the follow up.Conclusion: QD formulation of Tac showed excellent graft and patientsurvival also in highly sensitized patients. A careful care is mandatory in earlyKT to achieve a therapeutic trough Tac levels.