Five-year outcomes in living donor kidney transplants with a positive crossmatch

A. Bentall, L. D. Cornell, J. M. Gloor, W. D. Park, M. J. Gandhi, J. L. Winters, M. F. Chedid, P. G. Dean, M. D. Stegall

Research output: Contribution to journalArticlepeer-review

135 Scopus citations

Abstract

Renal transplant candidates with high levels of donor-specific anti-HLA antibodies have low transplantation rates and high mortality rates on dialysis. Using desensitization protocols, good short-term outcomes are possible in "positive crossmatch kidney transplants (+XMKTx)", but long-term outcome data are lacking. The aim of the current study was to determine actual 5-year graft outcomes of +XMKTx. We compared graft survival and the functional and histologic status of 102 +XMKTx to 204 -XMKTx matched for age and sex. Actual 5-year death-censored graft survival was lower in the +XMKTx group (70.7% vs. 88.0%, p < 0.01) and chronic injury (glomerulopathy) was present in 54.5% of surviving grafts. Graft survival was higher in recipients with antibody against donor class I only compared with antibody against class II (either alone or in combination with class I) (85.3% vs. 62.6%, p = 0.05) and was similar to -XMKTx (85.3 vs. 88.0%, p = 0.64). Renal function and proteinuria ranged across a wide spectrum in all groups reflecting the different histological findings at 5 years. We conclude that when compared to -XMKTx, +XMKTx have inferior outcomes at 5 years, however, almost half of the surviving grafts do not have glomerulopathy and avoiding antibodies against donor class II may improve outcomes. This study demonstrates that patients with anti-class II donor-specific antibodies at baseline in positive crossmatch kidney transplants have increased early transplant glomerulopathy at one year and higher rates of graft loss compared to anti-class I antibodies alone.

Original languageEnglish (US)
Pages (from-to)76-85
Number of pages10
JournalAmerican Journal of Transplantation
Volume13
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Antibody-mediated rejection
  • HLA-sensitized patients
  • Long-term outcomes
  • donor-specific antibodies
  • positive crossmatch kidney transplant

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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