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 language | English (US) |
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Pages (from-to) | 76-85 |
Number of pages | 10 |
Journal | American Journal of Transplantation |
Volume | 13 |
Issue number | 1 |
DOIs | |
State | Published - 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)