Positive crossmatch kidney transplant recipients treated with eculizumab: Outcomes beyond 1 year

L. D. Cornell, C. A. Schinstock, M. J. Gandhi, W. K. Kremers, M. D. Stegall

Research output: Contribution to journalArticlepeer-review

111 Scopus citations

Abstract

This study examined outcomes beyond 1 year in eculizumab-treated (EC) positive crossmatch kidney transplants (+XMKTx) compared to a historical control group. +XMKTx received desensitization with either plasma exchange (PE) alone (N = 48) or PE and EC (N = 30). EC, given for at least 1 month, was continued in the setting of persistently high DSA (B flow cytometric crossmatch [BFXM] >200) including: 4 weeks (n = 14); 9 weeks (n = 6), 6 months (n = 2), and 12 months (n = 8). All patients had at least 2 years follow-up. The incidence of acute clinical ABMR was lower in the EC group than controls (6.7% vs. 43.8% p < 0.01). Death-censored allograft survival was similar between groups. Chronic ABMR was the main cause of graft loss. On 1-year protocol biopsies, no differences were noted between EC and controls including: cg score >0, 26.7% versus 31.9% (p = 0.62), ptc score ≥ 2, 60.0% versus 60.0% (p = 1.00), or C4d +, 33.8% versus 13.5% (p = 0.08). A persistently high BFXM in EC-treated patients was associated with cg score >0 at 1 year, while EC appeared to protect against cg if the BFXM remained low. We conclude that despite decreasing acute clinical ABMR rates, EC treatment does not prevent chronic ABMR in recipients with persistently high BFXM after +XMKTx.

Original languageEnglish (US)
Pages (from-to)1293-1302
Number of pages10
JournalAmerican Journal of Transplantation
Volume15
Issue number5
DOIs
StatePublished - May 1 2015

Keywords

  • Alloantibody
  • antibody-mediated (ABMR)
  • chronic
  • crossmatch
  • fusion proteins
  • immunosuppressant
  • monoclonal antibodies

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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