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Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies.

Abstract：

BACKGROUND:Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. METHODS:Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. RESULTS:Patients had a mean number of 1.6 ± 0.8 DSAs with a mean fluorescence intensity value of 2,815 ± 2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129 ± 49 and 159 ± 52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA- groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA- group were similar. Two DSA+ (3%) and five DSA- (2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4 ± 0.6 mg/dL). CONCLUSION:Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSA- patients with pretransplantation immunologic risk assessment.

journal_name

Transplantation

journal_title

Transplantation

authors

Marfo K,Ajaimy M,Colovai A,Kayler L,Greenstein S,Lubetzky M,Gupta A,Kamal L,de Boccardo G,Masiakos P,Kinkhabwala M,Akalin E

doi

10.1097/TP.0000000000000191

subject

Has Abstract

pub_date

2014-11-27 00:00:00

pages

1082-8

issue

eissn

0041-1337

issn

1534-6080

journal_volume

pub_type

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Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies.