Kidney Transplant With Low Levels of DSA or Low Positive B-Flow Crossmatch: An Underappreciated Option for Highly Sensitized Transplant Candidates.

Abstract:

BACKGROUND:Avoiding donor-specific antibody (DSA) is difficult for sensitized patients. Improved understanding of the risk of low level DSA is needed. METHODS:We retrospectively compared the outcomes of 954 patients transplanted with varied levels of baseline DSA detected by single antigen beads and B flow cytometric crossmatch (XM). Patients were grouped as follows: -DSA/-XM, +DSA/-XM, +DSA/low +XM, +DSA/high +XM, and -DSA/+XM and followed up for a mean of 4.1 ± 1.9 years (similar among groups, P = 0.49). RESULTS:Death-censored allograft survival was similar in all groups except the +DSA/high +XM group, which was lower at 79.1% versus 96.2% in the -DSA/-XM group (P < 0.01). The incidence of chronic antibody-mediated rejection (CAMR) based on surveillance biopsy was higher with increasing DSA (8.2% -DSA/-XM, 17.0% +DSA/-XM, 30.6% +DSA/low +XM, and 51.2% +DSA/high +XM, P < 0.01), but similar in groups without baseline DSA (8.1% -DSA/-XM vs 15.4% -DSA/+XM, P = 0.19). Having a calculated panel-reactive antibody (cPRA) of 80% or greater was independently associated with CAMR (hazard ratio, 5.2; P = 0.03) even when DSA was undetected at baseline. By 2 years posttransplant, the incidence of CAMR was 19.4% in patients with cPRA of 80% or greater and undetected DSA and negative XM at baseline. CONCLUSIONS:Kidney transplantation with low-level DSA with or without a low positive XM is a reasonable option for highly sensitized patients and may be advantageous compared with waiting for a negative XM deceased donor. The risk for CAMR is low in patients with no DSA even if the XM is positive. Patients with cPRA of 80% or greater are at risk for CAMR even if no DSA is detected.

journal_name

Transplantation

journal_title

Transplantation

authors

Schinstock CA,Gandhi M,Cheungpasitporn W,Mitema D,Prieto M,Dean P,Cornell L,Cosio F,Stegall M

doi

10.1097/TP.0000000000001619

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

2429-2439

issue

10

eissn

0041-1337

issn

1534-6080

journal_volume

101

pub_type

杂志文章
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    doi:

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    更新日期:1990-01-01 00:00:00

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    authors: Jaksch M,Remberger M,Mattsson J

    更新日期:2004-01-27 00:00:00

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    doi:

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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

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    更新日期:2017-07-01 00:00:00

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    更新日期:2011-07-27 00:00:00

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    pub_type: 杂志文章

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    更新日期:1986-01-01 00:00:00

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    更新日期:2005-02-15 00:00:00

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    pub_type: 杂志文章

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    更新日期:2007-07-27 00:00:00

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    pub_type: 杂志文章

    doi:

    authors: Zachary AA,Braun WE,Hayes JM,McElroy JB,Novick AC,Schulak JA,Sharp WV

    更新日期:1994-04-15 00:00:00