Renal Transplantation in High Immunological Risk Patients: A Single-Center Experience.
Adult
Antibodies
/ immunology
Delayed Graft Function
/ immunology
Desensitization, Immunologic
/ statistics & numerical data
Female
Graft Rejection
/ immunology
Graft Survival
/ immunology
Humans
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Plasmapheresis
/ statistics & numerical data
Risk Factors
Rituximab
/ therapeutic use
Journal
Transplantation proceedings
ISSN: 1873-2623
Titre abrégé: Transplant Proc
Pays: United States
ID NLM: 0243532
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
16
12
2018
revised:
23
03
2019
accepted:
03
04
2019
pubmed:
14
8
2019
medline:
25
12
2019
entrez:
14
8
2019
Statut:
ppublish
Résumé
Renal transplantation (RT) in high-risk patients is increasingly performed due to an inadequate organ pool and increased rate of RT after a failed transplantation. Safety and prognosis of RT in such patients with high risk is an ongoing debate. Herein we aimed to present our single-center experience on RT of high-risk patients. A total of 89 consecutive RT patients were included into this study in a 10-month period. Patients were divided into 3 groups: the low-risk group (n = 47) with negative panel reactive antibody (PRA), medium-risk group (n = 18) with positive PRA but mean fluorescence intensity (MFI) < 2000, and high-risk group (n = 24) with positive PRA and MFI >2000 or donor specific antibody (DSA) positivity. Groups were compared in terms of demographic features, serum creatinine levels, acute rejection rates, delayed graft function (DGF), and patient or graft loss. Age of the recipients were similar between the groups. Desensitization (7% vs 11% vs 42%, respectively, in low-, medium-, and high-risk groups; P = .001), plasmapheresis (6% vs 11% vs 46%, respectively, P < .001), and rituximab treatments (0% vs 0% vs 25%, respectively, P < .001) were significantly more frequently performed in high-risk patients. Serum creatinine levels at 1 month and 6 months after RT were similar between the groups (P = .43 and P = .71, respectively). Rates of acute rejection (6% vs 6% vs 16%, respectively, P = .52) and DGF (9% vs 11% vs 29%, respectively, P = .15) were similar between the groups. Frequencies of loss of patient or graft were also similar (0% vs 6% vs 4%, P = .15). RT may be successfully performed in high-risk patients without an increase in the risk of acute rejection, DGF, or patient/graft loss.
Sections du résumé
BACKGROUND
BACKGROUND
Renal transplantation (RT) in high-risk patients is increasingly performed due to an inadequate organ pool and increased rate of RT after a failed transplantation. Safety and prognosis of RT in such patients with high risk is an ongoing debate. Herein we aimed to present our single-center experience on RT of high-risk patients.
METHODS
METHODS
A total of 89 consecutive RT patients were included into this study in a 10-month period. Patients were divided into 3 groups: the low-risk group (n = 47) with negative panel reactive antibody (PRA), medium-risk group (n = 18) with positive PRA but mean fluorescence intensity (MFI) < 2000, and high-risk group (n = 24) with positive PRA and MFI >2000 or donor specific antibody (DSA) positivity. Groups were compared in terms of demographic features, serum creatinine levels, acute rejection rates, delayed graft function (DGF), and patient or graft loss.
RESULTS
RESULTS
Age of the recipients were similar between the groups. Desensitization (7% vs 11% vs 42%, respectively, in low-, medium-, and high-risk groups; P = .001), plasmapheresis (6% vs 11% vs 46%, respectively, P < .001), and rituximab treatments (0% vs 0% vs 25%, respectively, P < .001) were significantly more frequently performed in high-risk patients. Serum creatinine levels at 1 month and 6 months after RT were similar between the groups (P = .43 and P = .71, respectively). Rates of acute rejection (6% vs 6% vs 16%, respectively, P = .52) and DGF (9% vs 11% vs 29%, respectively, P = .15) were similar between the groups. Frequencies of loss of patient or graft were also similar (0% vs 6% vs 4%, P = .15).
CONCLUSION
CONCLUSIONS
RT may be successfully performed in high-risk patients without an increase in the risk of acute rejection, DGF, or patient/graft loss.
Identifiants
pubmed: 31405734
pii: S0041-1345(18)31776-7
doi: 10.1016/j.transproceed.2019.04.075
pii:
doi:
Substances chimiques
Antibodies
0
Rituximab
4F4X42SYQ6
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2298-2301Informations de copyright
Copyright © 2019. Published by Elsevier Inc.