HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation
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. One hundred thirty-four HLA incompatible renal t...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-08-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001183 |
| _version_ | 1819086159129608192 |
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| author | Nithya Krishnan, MD, FRCP Aisha Abimbola, MSc Nandhini Machan, MSc Sunil Daga, PhD, FRCP Kishore Gopalakrishnan, MBBS, FRCPath ForTai Lam, MD, FRCS LamChin Tan, MD, FRCS Habib Kashi, MD, FRCS Christopher Imray, MD, FRCS Daniel Zehnder, PhD, FRCP Claire Collins, BSc Rebecca Curtis, BSc Robert Higgins, MD, FRCP Natasha Khovanova, PhD David Briggs, PhD |
| author_facet | Nithya Krishnan, MD, FRCP Aisha Abimbola, MSc Nandhini Machan, MSc Sunil Daga, PhD, FRCP Kishore Gopalakrishnan, MBBS, FRCPath ForTai Lam, MD, FRCS LamChin Tan, MD, FRCS Habib Kashi, MD, FRCS Christopher Imray, MD, FRCS Daniel Zehnder, PhD, FRCP Claire Collins, BSc Rebecca Curtis, BSc Robert Higgins, MD, FRCP Natasha Khovanova, PhD David Briggs, PhD |
| author_sort | Nithya Krishnan, MD, FRCP |
| collection | DOAJ |
| description | 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. 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. 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, P = 0.007; CDC/Flow, P = 0.001; and microbead assay/flow cytometry crossmatch, P = 0.837), although those with a low CDC titer (<1 in 2) have comparable outcomes to the CDC negative group. Female patients in general fared worse in both patient and graft survival outcomes in each of the 3 groups based on pretreatment crossmatch, although this did not reach statistical significance. Antibody-mediated rejection was the most frequent type of rejection with significant decline in graft survival by 10 y when compared with no rejection (P < 0.001). Rejection that occurred or continued to occur after the first 2 wk of transplantation caused a significant reduction in graft survivals (P < 0.001), whereas good outcomes were seen in those with a single early rejection episode.
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. |
| first_indexed | 2024-12-21T21:15:49Z |
| format | Article |
| id | doaj.art-46735e2ec3e84525b8fc3d211825391e |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-21T21:15:49Z |
| publishDate | 2021-08-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-46735e2ec3e84525b8fc3d211825391e2022-12-21T18:50:01ZengWolters KluwerTransplantation Direct2373-87312021-08-0178e73210.1097/TXD.0000000000001183202108000-00014HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor TransplantationNithya Krishnan, MD, FRCP0Aisha Abimbola, MSc1Nandhini Machan, MSc2Sunil Daga, PhD, FRCP3Kishore Gopalakrishnan, MBBS, FRCPath4ForTai Lam, MD, FRCS5LamChin Tan, MD, FRCS6Habib Kashi, MD, FRCS7Christopher Imray, MD, FRCS8Daniel Zehnder, PhD, FRCP9Claire Collins, BSc10Rebecca Curtis, BSc11Robert Higgins, MD, FRCP12Natasha Khovanova, PhD13David Briggs, PhD141 Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust (UHCW), Coventry, United Kingdom.2 Centre for Innovative Research Across the Life Course, Coventry University, Coventry, United Kingdom.2 Centre for Innovative Research Across the Life Course, Coventry University, Coventry, United Kingdom.3 Renal Unit, St. James University Hospitals, Leeds, United Kingdom.1 Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust (UHCW), Coventry, United Kingdom.1 Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust (UHCW), Coventry, United Kingdom.1 Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust (UHCW), Coventry, United Kingdom.1 Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust (UHCW), Coventry, United Kingdom.1 Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust (UHCW), Coventry, United Kingdom.4 Department of Medicine, North Cumbria University Hospitals NHS Trust, Carlisle, United Kingdom.5 H&I Laboratory, NHS Blood and Transplant, Birmingham, United Kingdom.6 Department of Statistics, NHS Blood and Transplant, Bristol, United Kingdom.1 Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust (UHCW), Coventry, United Kingdom.7 School of Engineering, University of Warwick, Coventry, United Kingdom.5 H&I Laboratory, NHS Blood and Transplant, Birmingham, United Kingdom.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. 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. 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, P = 0.007; CDC/Flow, P = 0.001; and microbead assay/flow cytometry crossmatch, P = 0.837), although those with a low CDC titer (<1 in 2) have comparable outcomes to the CDC negative group. Female patients in general fared worse in both patient and graft survival outcomes in each of the 3 groups based on pretreatment crossmatch, although this did not reach statistical significance. Antibody-mediated rejection was the most frequent type of rejection with significant decline in graft survival by 10 y when compared with no rejection (P < 0.001). Rejection that occurred or continued to occur after the first 2 wk of transplantation caused a significant reduction in graft survivals (P < 0.001), whereas good outcomes were seen in those with a single early rejection episode. 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.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001183 |
| spellingShingle | Nithya Krishnan, MD, FRCP Aisha Abimbola, MSc Nandhini Machan, MSc Sunil Daga, PhD, FRCP Kishore Gopalakrishnan, MBBS, FRCPath ForTai Lam, MD, FRCS LamChin Tan, MD, FRCS Habib Kashi, MD, FRCS Christopher Imray, MD, FRCS Daniel Zehnder, PhD, FRCP Claire Collins, BSc Rebecca Curtis, BSc Robert Higgins, MD, FRCP Natasha Khovanova, PhD David Briggs, PhD HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation Transplantation Direct |
| title | HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation |
| title_full | HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation |
| title_fullStr | HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation |
| title_full_unstemmed | HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation |
| title_short | HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation |
| title_sort | hla antibody incompatible renal transplantation long term outcomes similar to deceased donor transplantation |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001183 |
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