Significant Long-Term Prevention of High Sensitization After Kidney Allograft Failure by Maintaining Calcineurin Inhibitor-Based Immunosuppression.
Humans
Male
Female
Kidney Transplantation
/ adverse effects
Calcineurin Inhibitors
/ therapeutic use
Middle Aged
Follow-Up Studies
Graft Rejection
/ prevention & control
Graft Survival
/ drug effects
Risk Factors
Immunosuppressive Agents
/ therapeutic use
Prognosis
Kidney Failure, Chronic
/ surgery
Adult
Glomerular Filtration Rate
Retrospective Studies
Postoperative Complications
/ prevention & control
Kidney Function Tests
Immunosuppression Therapy
/ methods
high sensitization
immunosuppressive therapy
kidney allograft failure
kidney transplantation
waiting list
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
Jul 2024
Jul 2024
Historique:
revised:
07
06
2024
received:
20
11
2023
accepted:
14
06
2024
medline:
13
7
2024
pubmed:
13
7
2024
entrez:
13
7
2024
Statut:
ppublish
Résumé
Broad national or international programs contribute to mitigating the expected longer waiting list (WL) time for sensitized patients but with minor benefits for highly sensitized subjects. Therefore, strategies to prevent high sensitization are urgently required. In this study, we investigated the risk of developing highly sensitized patients with different immunosuppressive (IS) handling after kidney allograft failure (KAF). Data from 185 patients with KAF, retransplanted/relisted from 2010 to 2020 in two regions of Italy that share the same regional WL, were analyzed. Patients were categorized according to IS management at 12 months after KAF as follows: patients maintaining IS with calcineurin inhibitors (CNI) (late withdrawal group [LWG], n = 58) and those who withdrew all IS therapy or were on steroids only (early withdrawal group [EWG], n = 127). Patients in the LWG showed lower panel reactive antibodies (PRA) at 12 (29.0% vs. 85.5%, p < 0.001) and 24 months (61.0% vs. 91.0%, p = 0.001), reduced risk of high sensitization (PRA ≥90%) at 12 (9.4% vs. 40.7%, p < 0.001, OR = 0.15) and 24 months (25.6% vs. 57.3%, p = 0.001, OR = 0.26) and almost no very high sensitization (PRA ≥ 98%) at 12 months (1.9% vs. 18.6%, p = 0.003, OR = 0.08) after KAF. In the LWG subgroup analysis, patients who maintained IS for up to 24 months after KAF did not show very high sensitization. The LWG showed shorter active WL times (406 vs. 813 days, p = 0.001) without an increased risk of complications. CNI maintenance for at least 12 months after KAF could be a useful approach to prevent high sensitization and reduce WL times in patients who are offered retransplantation, without a higher burden of complications.
Substances chimiques
Calcineurin Inhibitors
0
Immunosuppressive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15394Informations de copyright
© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
P. S. Rao, D. E. Schaubel, X. Jia, S. Li, F. K. Port, and R. Saran, “Survival on Dialysis Post‐Kidney Transplant Failure: Results From the Scientific Registry of Transplant Recipients,” American Journal of Kidney Diseases is the Official Journal of the National Kidney Foundation 49, no. 2 (2007): 294–300, https://doi.org/10.1053/j.ajkd.2006.11.022.
R. Kabani, R. R. Quinn, S. Palmer, et al., “Risk of Death Following Kidney Allograft Failure: A Systematic Review and Meta‐Analysis of Cohort Studies,” Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association—European Renal Association 29, no. 9 (2014): 1778–1786, https://doi.org/10.1093/ndt/gfu205.
A. M. Huml and A. R. Sehgal, “Hemodialysis Quality Metrics in the First Year Following a Failed Kidney Transplant,” American Journal of Nephrology 50, no. 3 (2019): 161–167, https://doi.org/10.1159/000501605.
M. Bonani, R. Achermann, H. Seeger, et al., “Dialysis After Graft Loss: A Swiss Experience,” Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association—European Renal Association 35, no. 12 (2020): 2182–2190, https://doi.org/10.1093/ndt/gfaa037.
B. Kaplan and H.‐U. Meier‐Kriesche, “Death After Graft Loss: An Important Late Study Endpoint in Kidney Transplantation,” American Journal of Transplantation 2, no. 10 (2002): 970–974, https://doi.org/10.1034/j.1600‐6143.2002.21015.x.
R. A. Wolfe, V. B. Ashby, E. L. Milford, et al., “Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant,” New England Journal of Medicine 341, no. 23 (1999): 1725–1730, https://doi.org/10.1056/NEJM199912023412303.
A. Ojo, R. A. Wolfe, L. Y. Agodoa, et al., “Prognosis After Primary Renal Transplant Failure and the Beneficial Effects of Repeat Transplantation: Multivariate Analyses From the United States Renal Data System,” Transplantation 66, no. 12 (1998): 1651–1659, https://doi.org/10.1097/00007890‐199812270‐00014.
S. Clark, M. Kadatz, J. Gill, and J. S. Gill, “Access to Kidney Transplantation After a Failed First Kidney Transplant and Associations With Patient and Allograft Survival: An Analysis of National Data to Inform Allocation Policy,” Clinical Journal of the American Society of Nephrology 14, no. 8 (2019): 1228–1237, https://doi.org/10.2215/CJN.01530219.
A. Kainz, M. Kammer, R. Reindl‐Schwaighofer, et al., “Waiting Time for Second Kidney Transplantation and Mortality,” Clinical Journal of the American Society of Nephrology 17, no. 1 (2022): 90–97, https://doi.org/10.2215/CJN.07620621.
A. Hart, J. M. Smith, M. A. Skeans, et al., “OPTN/SRTR 2017 Annual Data Report: Kidney,” American Journal of Transplantation 19, no. Suppl 2 (2019): 19–123, https://doi.org/10.1111/ajt.15274.
A. R. Wilk, J. Beck, and A. Y. Kucheryavaya, The Kidney Allocation System (KAS): The First Two Years (2017): 1–63, https://unos.org/wp‐content/uploads/KAS_First‐two‐years_041917.pdf .
D. Zecher, F. Zeman, T. Drasch, et al., “Impact of Sensitization on Waiting Time Prior to Kidney Transplantation in Germany,” Transplantation 106, no. 12 (2022): 2448–2455, https://doi.org/10.1097/TP.0000000000004238.
R. Halieutiques, B. Faso, K. U. Leuven, and G. Terres, Agence de la Biomédecine (2003), https://rams.agence‐biomedecine.fr/greffe‐renale‐0.
H. de Ferrante, B. Smeulders, I. Tieken, et al., “Immunized Patients Face Reduced Access to Transplantation in the Eurotransplant Kidney Allocation System,” Transplantation 107, no. 10 (2023): 2247–2254, https://doi.org/10.1097/TP.0000000000004687.
L. Ghyselen and M. Naesens, “Indications, Risks and Impact of Failed Allograft Nephrectomy,” Transplantation Reviews 33, no. 1 (2019): 48–54, https://doi.org/10.1016/j.trre.2018.08.001.
A. Del Bello, N. Congy‐Jolivet, F. Sallusto, et al., “Donor‐Specific Antibodies After Ceasing Immunosuppressive Therapy, With or Without an Allograft Nephrectomy,” Clinical Journal of the American Society of Nephrology 7, no. 8 (2012): 1310–1319, https://doi.org/10.2215/CJN.00260112.
G. Lucisano, P. Brookes, E. Santos‐Nunez, et al., “Allosensitization After Transplant Failure: The Role of Graft Nephrectomy and Immunosuppression—A Retrospective Study,” Transpl Int Off J Eur Soc Organ Transplant 32, no. 9 (2019): 949–959, https://doi.org/10.1111/tri.13442.
J. J. Augustine, K. J. Woodside, A. Padiyar, E. Q. Sanchez, D. E. Hricik, and J. A. Schulak, “Independent of Nephrectomy, Weaning Immunosuppression Leads to Late Sensitization After Kidney Transplant Failure,” Transplantation 94, no. 7 (2012): 738–743, https://doi.org/10.1097/TP.0b013e3182612921.
A. Nimmo , S. McIntyre, D. M. Turner, L. K. Henderson, and R. K. Battle, “The Impact of Withdrawal of Maintenance Immunosuppression and Graft Nephrectomy on HLA Sensitization and Calculated Chance of Future Transplant,” Transplantation Direct 4, no. 12 (2018): e409, https://doi.org/10.1097/TXD.0000000000000848.
P. Singh, F. Ej, C. Bw, S. Ap, T. Zhan, and M. Harach, “Sensitization Trends After Renal Allograft Failure: The Role of DQ Eplet Mismatches in Becoming Highly Sensitized,” Clinical Transplantation 30, no. 1 (2016): 71–80, https://doi.org/10.1111/ctr.12663.
V. Kosmoliaptsis, O. Gjorgjimajkoska, L. D. Sharples, et al., “Impact of Donor Mismatches at Individual HLA‐A, ‐B, ‐C, ‐DR, and ‐DQ loci on the Development Of HLA‐specific Antibodies in Patients Listed for Repeat Renal Transplantation,” Kidney International 86, no. 5 (2014): 1039–1048, https://doi.org/10.1038/ki.2014.106.
J. C. Scornik and H.‐U. M. Kriesche, “Human Leukocyte Antigen Sensitization After Transplant Loss: Timing of Antibody Detection and Implications for Prevention,” Human Immunology 72, no. 5 (2011): 398–401, https://doi.org/10.1016/j.humimm.2011.02.018.
M. J. Casey, X. Wen, L. K. Kayler, R. Aiyer, J. C. Scornik, and H.‐U. Meier‐Kriesche, “Prolonged Immunosuppression Preserves Nonsensitization Status After Kidney Transplant Failure,” Transplantation 98, no. 3 (2014): 306–311, https://doi.org/10.1097/TP.0000000000000057.
G. Knoll, P. Campbell, M. Chassé, et al., “Immunosuppressant Medication Use in Patients With Kidney Allograft Failure: A Prospective Multicenter Canadian Cohort Study,” Journal of the American Society of Nephrology 33, no. 6 (2022): 1182 LP–1181192, https://doi.org/10.1681/ASN.2021121642.
K. Martin, L. Cantwell, K. A. Barraclough, et al., “Prolonged Immunosuppression Does Not Improve Risk of Sensitization or Likelihood of Re‐Transplantation After Kidney Transplant Graft Failure,” Transplant International 34, no. 11 (2021): 2353–2362, https://doi.org/10.1111/tri.13998.
S. Balakrishnan, B. Smith, A. Bentall, et al., “Effect of Maintaining Immunosuppression After Kidney Allograft Failure on Mortality and Re‐Transplantation,” Transplant Direct 9, no. 1 (2022): E1415, https://doi.org/10.1097/TXD.0000000000001415.
A. Elgenidy, R. S. Shemies, M. Atef, et al., “Revisiting Maintenance Immunosuppression in Patients With Renal Transplant Failure: Early Weaning of Immunosuppression Versus Prolonged Maintenance—Systematic Review and Meta‐Analysis,” Journal of Nephrology 36, no. 2 (2023): 537–550, https://doi.org/10.1007/s40620‐022‐01458‐y.
K. Ferrari, A. Aarnink, C. Ayav, et al., “Evolution of HLA‐Sensitization According to Immunosuppressive Therapy Management Among Kidney Transplant Patients Returning to Dialysis Between 2008 and 2019: A French Retrospective Study,” Clinical Transplantation 38, no. 1 (2023): e15160, https://doi.org/10.1111/ctr.15160.
P. J. Smak Gregoor, R. Zietse, J. L. van Saase, et al., “Immunosuppression Should be Stopped in Patients With Renal Allograft Failure,” Clinical Transplantation 15, no. 6 (2001): 397–401, https://doi.org/10.1034/j.1399‐0012.2001.150606.x.
H. Ryu, Y. C. Kim, J. J. Moon, et al., “Weaning Immunosuppressant in Patients With Failing Kidney Grafts and the Outcomes: A Single‐Center Retrospective Cohort Study,” Scientific Reports 10, no. 1 (2020): 6425, https://doi.org/10.1038/s41598‐020‐63266‐3.
K. J. Woodside, Z. W. Schirm, K. A. Noon, et al., “Fever, Infection, and Rejection After Kidney Transplant Failure,” Transplantation 97, no. 6 (2014): 648–653, https://doi.org/10.1097/01.TP.0000437558.75574.9c.
G. P. Bayliss, R. Y. Gohh, P. E. Morrissey, J. R. Rodrigue, and D. A. Mandelbrot, “Immunosuppression After Renal Allograft Failure: A Survey of US Practices,” Clinical Transplantation 27, no. 6 (2013): 895–900, https://doi.org/10.1111/ctr.12254.
T. Alhamad, M. Lubetzky, K. L. Lentine, et al., “Kidney Recipients With Allograft Failure, Transition of Kidney Care (KRAFT): A Survey of Contemporary Practices of Transplant Providers,” American Journal of Transplantation 21, no. 9 (2021): 3034–3042, https://doi.org/10.1111/ajt.16523.
M. Freist, D. Bertrand, E. Bailly, et al., “Management of Immunosuppression After Kidney Transplant Failure: Effect on Patient Sensitization,” Transplantation Proceedings 53, no. 3 (2021): 962–969, https://doi.org/10.1016/j.transproceed.2020.10.009.
C. López Del Moral Cuesta, S. Guiral Foz, D. Gómez Pereda, et al., “Immunosuppression With Calcineurin Inhibitor After Renal Transplant Failure Inhibits Allosensitization,” Biomedicines 8, no. 4 (2020): 72, https://doi.org/10.3390/biomedicines8040072.
N. Garg, K. Viney, J. Burger, et al., “Factors Affecting Sensitization Following Kidney Allograft Failure,” Clinical Transplantation 36, no. 3 (2022): e14558, https://doi.org/10.1111/ctr.14558.
M. Lubetzky, E. Tantisattamo, M. Z. Molnar, et al., “The Failing Kidney Allograft: A Review and Recommendations for the Care and Management of a Complex Group of Patients,” American Journal of Transplantation 21, no. 9 (2021): 2937–2949, https://doi.org/10.1111/ajt.16717.
S. Marinaki, C. Skalioti, and J. Boletis, “Patients After Kidney Allograft Failure: Immunologic and Nonimmunologic Considerations,” Transplantation Proceedings 47, no. 9 (2015): 2677–2682, https://doi.org/10.1016/j.transproceed.2015.09.054.
C. Lefaucheur, C. Antoine, C. Suberbielle, and D. Glotz, “Mastering the Risk of HLA Antibodies in Kidney Transplantation: An Algorithm Based on Pretransplant Single‐Antigen Flow Bead Techniques,” American Journal of Transplantation 11, no. 8 (2011): 1592–1598, https://doi.org/10.1111/j.1600‐6143.2011.03560.x.
T. Alhamad, H. Murad, D. M. Dadhania, et al., “The Perspectives of General Nephrologists Toward Transitions of Care and Management of Failing Kidney Transplants,” Transplant International 36 (2023): 11172, https://doi.org/10.3389/ti.2023.11172.
P. A. Andrews, “Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant,” Transplantation 98, no. 11 (2014): 1130–1133, https://doi.org/10.1097/TP.0000000000000426.
J. Noelle, V. Mayet, C. Lambert, et al., “Impact of Calcineurin Inhibitor‐Based Immunosuppression Maintenance During the Dialysis Period After Kidney Transplant Failure on the Next Kidney Graft Outcome: A Retrospective Multicenter Study With Propensity Score Analysis,” Transplant International 36 (2023): 11775, https://doi.org/10.3389/ti.2023.11775.
Centro Nazionale Trapianti, Protocollo nazionale iperimmuni (2017), https://www.trapianti.salute.gov.it/imgs/C_17_cntPubblicazioni_15_allegato.pdf.
D. Tittelbach‐Helmrich, P. Pisarski, G. Offermann, et al., “Impact of Transplant Nephrectomy on Peak PRA Levels and Outcome After Kidney Re‐Transplantation,” World Journal of Transplantation 4, no. 2 (2014): 141–147, https://doi.org/10.5500/wjt.v4.i2.141.
A. Elgenidy, R. S. Shemies, M. Atef, et al., “Revisiting Maintenance Immunosuppression in Patients With Renal Transplant Failure: Early Weaning of Immunosuppression Versus Prolonged Maintenance‐Systematic Review and Meta‐Analysis,” Journal of Nephrology 36, no. 10: (2022), https://doi.org/10.1007/s40620‐022‐01458‐y.
D. S. Keith, M. Cantarovich, S. Paraskevas, and J. Tchervenkov, “Duration of Dialysis Pretransplantation is an Important Risk Factor for Delayed Recovery of Renal Function Following Deceased Donor Kidney Transplantation,” Transplant International 21, no. 2 (2008): 126–132, https://doi.org/10.1111/j.1432‐2277.2007.00571.x.