HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation.
Journal
Transplantation direct
ISSN: 2373-8731
Titre abrégé: Transplant Direct
Pays: United States
ID NLM: 101651609
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
16
04
2021
revised:
04
05
2021
accepted:
05
05
2021
entrez:
22
7
2021
pubmed:
23
7
2021
medline:
23
7
2021
Statut:
epublish
Résumé
HLA incompatible renal transplantation still remains one of best therapeutic options for a subgroup of patients who are highly sensitized and difficult to match but not much is known about its long-term graft and patient survival. One hundred thirty-four HLA incompatible renal transplantation patients from 2003 to 2018 with a median follow of 6.93 y were analyzed retrospectively to estimate patient and graft survivals. Outcomes were compared with groups defined by baseline crossmatch status and the type and timings of rejection episodes. The overall patient survival was 95%, 90%, and 81%; and graft survival was 95%, 85%, and 70% at 1, 5, and 10 y, respectively. This was similar to the first-time deceased donor transplant cohort. The graft survival for pretreatment cytotoxic-dependent crossmatch (CDC) positive crossmatch group was significantly low at 83%, 64%, and 40% at 1, 5, and 10 y, respectively, compared with other groups (Bead/CDC, One-, 5-, and 10-y HLA incompatible graft and patient survival is comparable to deceased donor transplantation and can be further improved by excluding high-CDC titer cases. Antibody-positive female patients show worse long-term survival. Resolution of early rejection is associated with good long-term graft survival.
Sections du résumé
BACKGROUND
BACKGROUND
HLA incompatible renal transplantation still remains one of best therapeutic options for a subgroup of patients who are highly sensitized and difficult to match but not much is known about its long-term graft and patient survival.
METHODS
METHODS
One hundred thirty-four HLA incompatible renal transplantation patients from 2003 to 2018 with a median follow of 6.93 y were analyzed retrospectively to estimate patient and graft survivals. Outcomes were compared with groups defined by baseline crossmatch status and the type and timings of rejection episodes.
RESULTS
RESULTS
The overall patient survival was 95%, 90%, and 81%; and graft survival was 95%, 85%, and 70% at 1, 5, and 10 y, respectively. This was similar to the first-time deceased donor transplant cohort. The graft survival for pretreatment cytotoxic-dependent crossmatch (CDC) positive crossmatch group was significantly low at 83%, 64%, and 40% at 1, 5, and 10 y, respectively, compared with other groups (Bead/CDC,
CONCLUSIONS
CONCLUSIONS
One-, 5-, and 10-y HLA incompatible graft and patient survival is comparable to deceased donor transplantation and can be further improved by excluding high-CDC titer cases. Antibody-positive female patients show worse long-term survival. Resolution of early rejection is associated with good long-term graft survival.
Identifiants
pubmed: 34291154
doi: 10.1097/TXD.0000000000001183
pmc: PMC8291351
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e732Informations de copyright
Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
N.K., D.B., and N.K. received funds from Chiesi, Sandoz, Astella, VH Bio, One Lambda, Immucor, Biomerieux, and Warwick School of Engineering toward organizing an International Transplantation Conference. N.K. and D.B. have been part of scientific advisory board for HANSA Ltd. The remaining authors have any conflict of interest.
Références
Transplantation. 2011 Oct 27;92(8):900-6
pubmed: 21968524
Transplantation. 2014 Jun 27;97(12):1247-52
pubmed: 24854670
Am J Transplant. 2006 May;6(5 Pt 1):1033-41
pubmed: 16611341
Sci Rep. 2019 Feb 12;9(1):1863
pubmed: 30755659
Hum Immunol. 2015 Aug;76(8):546-52
pubmed: 26116896
Transplant Proc. 1997 Feb-Mar;29(1-2):1537-40
pubmed: 9123416
Clin J Am Soc Nephrol. 2011 Apr;6(4):922-36
pubmed: 21441131
J Reprod Immunol. 1996 Aug;31(1-2):81-95
pubmed: 8887124
Transplantation. 2009 Mar 27;87(6):882-8
pubmed: 19300192
Am J Transplant. 2003;3 Suppl 4:114-25
pubmed: 12694055
N Engl J Med. 2016 Mar 10;374(10):940-50
pubmed: 26962729
Am J Transplant. 2014 Feb;14(2):272-83
pubmed: 24472190
Hum Immunol. 2017 Jan;78(1):30-36
pubmed: 27773831
Nephrol Dial Transplant. 2015 Dec;30(12):1972-8
pubmed: 25500804
Am J Transplant. 2010 Mar;10(3):582-9
pubmed: 20121740
N Engl J Med. 1969 Apr 3;280(14):735-9
pubmed: 4886455
Lancet. 1996 Nov 2;348(9036):1208-11
pubmed: 8898038
N Engl J Med. 2018 Sep 20;379(12):1150-1160
pubmed: 30231232
Indian J Nephrol. 2012 Nov;22(6):409-14
pubmed: 23440400
Am J Transplant. 2009 Mar;9(3):536-42
pubmed: 19191764
Lancet. 2017 Feb 18;389(10070):727-734
pubmed: 28065559
Transplantation. 1984 Mar;37(3):254-5
pubmed: 6367164
Transplantation. 2015 Jul;99(7):1423-30
pubmed: 25606792
Transpl Int. 2015 Dec;28(12):1405-15
pubmed: 26264744
Am J Transplant. 2010 Mar;10(3):449-57
pubmed: 20121749
Transpl Int. 2021 Jan;34(1):153-162
pubmed: 33095917
J Am Soc Nephrol. 2015 Jul;26(7):1721-31
pubmed: 25556173
Transplantation. 2009 Jan 27;87(2):268-73
pubmed: 19155983