Lack of Association between Pretransplant Donor-Specific Antibodies and Posttransplant Kidney Outcomes in Simultaneous Liver-Kidney Transplant Recipients with Rabbit Anti-Thymocyte Globulin Induction and Steroid-Free Protocol.
Adult
Aged
Allografts
Antilymphocyte Serum
/ pharmacology
Female
Graft Rejection
/ etiology
Histocompatibility Antigens Class II
/ immunology
Humans
Isoantibodies
/ immunology
Kidney Transplantation
/ adverse effects
Liver Transplantation
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Tissue Donors
Donor-specific antibodies
Kidney outcome
Pretransplant donor-specific antibody
Simultaneous liver-kidney transplantation
Journal
Nephron
ISSN: 2235-3186
Titre abrégé: Nephron
Pays: Switzerland
ID NLM: 0331777
Informations de publication
Date de publication:
2020
2020
Historique:
received:
25
09
2019
accepted:
15
12
2019
pubmed:
3
2
2020
medline:
9
3
2021
entrez:
3
2
2020
Statut:
ppublish
Résumé
The impact of pretransplant donor-specific antibodies (DSAs), especially class II DSAs, on kidney allograft outcomes remains unclear in simultaneous liver-kidney transplantation (SLKT) recipients. We examined 85 recipients who consecutively underwent SLKT between 2009 and 2018 in our center. Associations between pretransplant DSA and worsening kidney function (WKF), kidney allograft loss, composite kidney outcome (WKF and/or antibody-mediated rejection and/or death-censored kidney allograft loss), death with functioning graft, and overall mortality were examined in survival analysis. WKF was defined as an eGFR decrease of 30% or greater from baseline, or 2 or more episodes of proteinuria, at least 90 days apart from each other. The mean age at SLKT was 56 ± 10 years, and 62% of the recipients were male. More than one quarter (26%) of our recipients were African American. The 2 major causes of end-stage liver disease were hepatitis C (28%) and alcoholic hepatitis (26%). Nineteen recipients (22%) had pretransplant DSAs at the time of SLKT. The DSA(+) group and DSA(-) group had similar risk of WKF (unadjusted model: hazard ratio [HR] = 0.77, 95% confidence interval [CI]: 0.29-2.05 and adjusted model: HR = 0.36, 95% CI: 0.12-1.08); similar risk of composite kidney outcome (unadjusted model: HR = 1.04, 95% CI: 0.45-2.43 and adjusted model: HR = 0.53, 95% CI: 0.20-1.39); and similar risk of overall death (unadjusted model: HR = 1.23, 95% CI: 0.45-3.36 and adjusted model: HR = 1.28, 95% CI: 0.42-3.87). We found similar results when comparing different DSA subclasses (class I and II DSAs) with recipients without DSAs. The presence of pretransplant DSAs was not associated with worse kidney allograft outcomes from our single-center experience. Further prospective larger studies are strongly warranted.
Identifiants
pubmed: 32007998
pii: 000505460
doi: 10.1159/000505460
doi:
Substances chimiques
Antilymphocyte Serum
0
Histocompatibility Antigens Class II
0
Isoantibodies
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
126-137Informations de copyright
© 2020 S. Karger AG, Basel.