Allosensitization after transplant failure: the role of graft nephrectomy and immunosuppression - a retrospective study.
Adult
Aged
Female
Histocompatibility Antigens Class I
/ immunology
Histocompatibility Antigens Class II
/ immunology
Humans
Immunosuppression Therapy
Immunosuppressive Agents
/ administration & dosage
Kidney Failure, Chronic
/ immunology
Male
Middle Aged
Nephrectomy
/ adverse effects
Postoperative Complications
/ immunology
Retrospective Studies
Tacrolimus
/ administration & dosage
Transplantation Immunology
allosensitization
donor-specific antibody
tacrolimus
transplant nephrectomy
Journal
Transplant international : official journal of the European Society for Organ Transplantation
ISSN: 1432-2277
Titre abrégé: Transpl Int
Pays: Switzerland
ID NLM: 8908516
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
22
11
2018
revised:
07
01
2019
accepted:
09
04
2019
pubmed:
14
4
2019
medline:
1
4
2020
entrez:
14
4
2019
Statut:
ppublish
Résumé
There are conflicting data about the role of transplant nephrectomy and immunosuppression withdrawal on the development of allosensitization and the impact on re-transplantation. We divided 109 first graft recipients into two groups according to whether they underwent nephrectomy (NX+, n = 61) or their graft was left in situ (NX-, n = 48). Sera were assessed for HLA-A/B/Cw/DR/DQ antibodies at the time of NX/transplant failure and after 3, 6, 12, 24 months. The NX+ group showed a higher rate of donor specific antibody (DSA) and non-DSA human leukocyte antigen (HLA) antibody production at all the time points. Multivariable analysis showed that nephrectomy was a strong, independent risk factor for the development of DSAs after 12 and 24 months (P = 0.005 and 0.008). In the NX- group, low tacrolimus levels correlated with DSA formation (AUC 0.817, P = 0.002; best cut-off level 2.9 ng/ml). Analysis with a standardized pool of UK donors showed a more difficult grade of HLA matchability following nephrectomy compared with the NX- group. Nephrectomy is followed by the long-term production of DSA and non-DSA HLA antibodies and negatively impacts on the chances of finding a HLA-compatible kidney. Tacrolimus levels ≥3 ng/ml are protective against the development of allosensitization and could facilitate re-transplantation in the NX- group.
Substances chimiques
Histocompatibility Antigens Class I
0
Histocompatibility Antigens Class II
0
Immunosuppressive Agents
0
Tacrolimus
WM0HAQ4WNM
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
949-959Informations de copyright
© 2019 Steunstichting ESOT.
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