Immortal Time-Bias-Corrected Survival of Highly Sensitized Patients and HLA-desensitized Kidney Transplant Recipients.
HLA-incompatible
desensitization
end-stage renal disease
kidney graft survival
kidney transplantation
patient survival
Journal
Kidney international reports
ISSN: 2468-0249
Titre abrégé: Kidney Int Rep
Pays: United States
ID NLM: 101684752
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
22
03
2021
revised:
04
07
2021
accepted:
26
07
2021
entrez:
8
10
2021
pubmed:
9
10
2021
medline:
9
10
2021
Statut:
epublish
Résumé
In the setting of kidney transplantation (KT), we assessed the efficacy of desensitization and compared the survival of desensitized patients (HLA-incompatible KT) with similarly sensitized patients receiving HLA-compatible KT or sensitized patients still on a waiting list after adjusting for the usually unaccounted immortal time bias. All patients in a French KT center on the waiting list between August 1994 and December 2019 with a high level of sensitization (panel-reactive antibodies [PRAs] ≥80%) were included. The primary outcome was all-cause mortality. A time-varying covariate Cox survival model was used to account for the immortal time bias. A landmark analysis was used as a sensitivity analysis. During the study period, 326 patients with high PRAs were followed, among which 147 (45%) remained on the waiting list at the time of last follow-up and 179 benefited from a KT. Thirty-six patients were desensitized, of which 30 received a kidney transplant, including eight deceased kidney donors. There were no differences in mortality rates between desensitized KT patients, nondesensitized KT patients, and waitlisted patients after adjusting for immortal time bias (hazard ratio [HR] = 0.48, HLA-desensitization was effective for highly sensitized patients and gave access to KT without detrimental effects on patient or graft survival rates.
Identifiants
pubmed: 34622102
doi: 10.1016/j.ekir.2021.07.024
pii: S2468-0249(21)01348-6
pmc: PMC8484495
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2629-2638Informations de copyright
© 2021 International Society of Nephrology. Published by Elsevier Inc.
Références
Lancet. 2015 May 16;385(9981):1975-82
pubmed: 25777665
Clin J Am Soc Nephrol. 2016 Apr 7;11(4):684-93
pubmed: 26915916
N Engl J Med. 2011 Jul 28;365(4):318-26
pubmed: 21793744
Transplantation. 2017 Mar;101(3):631-641
pubmed: 27120452
N Engl J Med. 1999 Dec 2;341(23):1725-30
pubmed: 10580071
Nephron Clin Pract. 2013;125(1-4):81-98
pubmed: 24662168
Transpl Int. 2018 Feb;31(2):125-130
pubmed: 29024071
Kidney Int. 2017 Jun;91(6):1266-1268
pubmed: 28501297
N Engl J Med. 2016 Jul 21;375(3):288-9
pubmed: 27468073
J Immunol Res. 2017;2017:5672523
pubmed: 28265581
J Immunol Res. 2017;2017:6804678
pubmed: 28127571
Pharmacoepidemiol Drug Saf. 2007 Mar;16(3):241-9
pubmed: 17252614
Transplantation. 2004 Jul 27;78(2):190-3
pubmed: 15280676
Am J Transplant. 2010 Jan;10(1):190
pubmed: 19889121
Clin J Am Soc Nephrol. 2018 Jan 6;13(1):182-192
pubmed: 28446536
Clin J Am Soc Nephrol. 2011 Apr;6(4):922-36
pubmed: 21441131
J Immunol Res. 2014;2014:845040
pubmed: 25374891
Transplantation. 2011 Jul 15;92(1):12-7
pubmed: 21512428
Am J Transplant. 2009 Mar;9(3):536-42
pubmed: 19191764
Lancet. 2017 Feb 18;389(10070):727-734
pubmed: 28065559
J Am Soc Nephrol. 2016 Feb;27(2):570-8
pubmed: 26054537
Stat Methods Med Res. 2018 Mar;27(3):832-845
pubmed: 27142981
Am J Transplant. 2020 Aug;20(8):2101-2112
pubmed: 32065704
Am J Epidemiol. 2005 Nov 15;162(10):1016-23
pubmed: 16192344
Am J Transplant. 2006 Feb;6(2):346-51
pubmed: 16426319
J Am Soc Nephrol. 2010 Aug;21(8):1398-406
pubmed: 20634297
Transpl Int. 2015 Oct;28(10):1205-15
pubmed: 26095452