Long-term outcomes of eculizumab-treated positive crossmatch recipients: Allograft survival, histologic findings, and natural history of the donor-specific antibodies

Carrie A. Schinstock, Andrew J. Bentall, Byron H. Smith, Lynn D. Cornell, Matthew Everly, Manish J. Gandhi, Mark D. Stegall

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

We aimed to determine the long-term outcomes of eculizumab-treated, positive crossmatch (+XM) kidney transplant recipients compared with +XM and age-matched negative crossmatch (−XM) controls. We performed an observational retrospective study and examined allograft survival, histologic findings, long-term B-cell flow cytometric XM (BFXM), and allograft-loss–associated factors. The mean (SD) posttransplant follow-up was 6.3 (2.5) years in the eculizumab group; 7.6 (3.5), +XM control group; 7.9 (2.5), −XM control group. The overall and death-censored allograft survival rates were similar in +XM groups (P =.73, P =.48) but reduced compared with −XM control patients (P <.001, P <.001). In the eculizumab-treated group, 57.9% (11/19) of the allografts had chronic antibody-mediated rejection, but death-censored allograft survival was 76.6%, 5 years; 75.4%, 7 years. Baseline IgG3 positivity and BFXM ≥300 were associated with allograft loss. C1q positivity was also associated with allograft loss but did not reach statistical significance. Donor-specific antibodies appeared to decrease in eculizumab-treated patients. After excluding patients with posttransplant plasmapheresis, 42.3% (9/21) had negative BFXMs; 31.8% (7/22), completely negative single-antigen beads 1 year posttransplant. Eculizumab-treated +XM patients had reduced allograft survival compared with −XM controls but similar survival to +XM controls. BFXM and complement-activating donor-specific antibodies (by IgG3 and C1q testing) may be used for risk stratification in +XM transplantation.

Original languageEnglish (US)
Pages (from-to)1671-1683
Number of pages13
JournalAmerican Journal of Transplantation
Volume19
Issue number6
DOIs
StatePublished - Jun 2019

Keywords

  • alloantibody
  • clinical research/practice
  • desensitization
  • histocompatibility
  • kidney transplantation/nephrology
  • organ transplantation in general
  • protocol biopsy
  • rejection: antibody-mediated (ABMR)
  • rejection: chronic

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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