Excellent outcome after desensitization in high immunologic risk kidney transplantation

Abstract

IntroductionHLA-incompatible (HLAi) and ABO-incompatible (ABOi) kidney transplantation (KT) has been on the increase over the last decade. However, there are wide variations in outcomes from these procedures. In this study we evaluated the graft and patient outcomes in incompatible KT and non-sensitized KT.MethodsPatients who underwent KT between January 2012 and April 2018 were enrolled and reviewed. We divided kidney transplant recipients (KTRs) into five groups as follows: HLAi (n = 50); ABOi (n = 65); HLAi+ABOi (n = 5); control (n = 428); and living-donor control (LD control, n = 218). We compared the risk of rejection, graft function, graft survival, and patient survival between incompatible KTRs and control/LD control KTRs.ResultsAlthough the incidence of active antibody-mediated rejection in HLAi group tends to be higher than in control and LD control groups (6.0% vs. 2.8%, P = 0.20; 6.0% vs. 3.7%, P = 0.44, respectively), the rejection-free survival, graft survival, and patient survival were not significantly different from those of the control and LD control groups in all three incompatible KT groups (all P>0.05). Graft function during the study period was also not different between incompatible KTRs and control/LD control groups (both P>0.05). Using Cox regression analysis, neither HLAi nor ABOi were risk factors for graft failure. Some infectious diseases such as urinary tract infection and cytomegalovirus infection were more common in the HLAi group than in the control/LD control group (both P<0.05), but only one infection-related death occurred in HLAi KTRs. Infection risks were similar in the ABOi and HLAi+ABOi groups compared to controls.ConclusionOur results showed favorable outcomes for incompatible KT after desensitization. Although desensitization therapy for incompatible KT has improved access to transplantation for KT candidates with high immunological risk, more clinical data are clearly needed.

Acute Rejection and Infectious Complications in ABO- and HLA-Incompatible Kidney Transplantations

“…Therefore, the 5-year overall PS (98%) and GS (92%) rates in this study showed much better outcomes than those in European and United Network for Organ Sharing data [ 39 , 40 ]. However, recent studies involving Asian or Korean patients have reported similar clinical outcomes as those in our study [ 41 , 42 ]. Consideration of these factors are needed to interpret the results.…”

Outcome of desensitization in human leukocyte antigen and ABO incompatible living donor kidney transplantation: Single center experience of first 200 incompatible transplants

“…The present study compares the characteristics of different kinds of living donor, incompatible kidney transplants. Published studies report that the proportion of female patients is higher in the HLAi group due to sensitization from pregnancy 14,15,22‐26 . This was different from the present study.…”

“…In the present study, a statistically significant difference was found in number of sensitizing events; blood transfusions, pregnancies and previous transplant between HLAc and HLAi recipients. This was similar to the study conducted by Lim et al 25 …”

“…However, this is more evident in India 28 . Lim et al reported lower BMI of recipients in the HLAi category due to inclusion of more females with history of sensitization in this category 25 . In contrast, the BMI of recipients in the present study were found to be similar for all categories.…”

“…However, BMI of recipients was found to be considerably lower than that of donors. Lim et al also reported shorter time to transplant from dialysis for the ABOi and HLAi + ABOi groups compared to the control group 25 . They explained this finding by the fact that since different blood types are no longer a serious hurdle when it comes to kidney transplants, hence, finding donors was easy for this category.…”