In Kidney Transplant Recipients With a Positive Virtual Crossmatch, High PRA was Associated With Lower Incidence of Viral Infections

Parajuli, Sandesh; Muth, Brenda; Turk, Jennifer; Astor, Brad C.; Mohammed, Maha; Mandelbrot, Didier A.; Djamali, Arjang

doi:10.1097/tp.0000000000001061

Cited by 12 publications

(10 citation statements)

References 23 publications

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“…Although aggressive immunosuppression is inevitable, limited information is available regarding infectious complications in positive-crossmatch KT. Two studies reported that viral infection was increased in positive-crossmatch KT patients; however, they did not contain a control group [29, 30]. A recent multicenter study reported that the rates of readmission owing to infectious complications in both HLA-incompatible group and control subjects were virtually the same [31].…”

Section: Discussionmentioning

confidence: 99%

Transplant outcomes in positive complement-dependent cytotoxicity- versus flow cytometry-crossmatch kidney transplant recipients after successful desensitization: a retrospective study

et al. 2019

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BackgroundDespite the obvious survival benefit compared to that among waitlist patients, outcomes of positive crossmatch kidney transplantation (KT) are generally inferior to those of human leukocyte antigen (HLA)-compatible KT. This study aimed to compare the outcomes of positive complement-dependent cytotoxicity (CDC) crossmatch (CDC + FC+) and positive flow cytometric crossmatch (CDC-FC+) with those of HLA-compatible KT (CDC-FC-) after successful desensitization.MethodsWe retrospectively analyzed 330 eligible patients who underwent KTs between June 2011 and August 2017: CDC-FC- (n = 274), CDC-FC+ (n = 39), and CDC + FC+ (n = 17). Desensitization protocol targeting donor-specific antibody (DSA) involved plasmapheresis, intravenous immunoglobulin (IVIG), and rituximab with/without bortezomib for positive-crossmatch KT.ResultsDeath-censored graft survival and patient survival were not different among the three groups. The median estimated glomerular filtration rate was significantly lower in the CDC + FC+ group than in the compatible group at 6 months (P < 0.001) and 2 years (P = 0.020). Biopsy-proven rejection within 1 year of CDC-FC-, CDC-FC+, and CDC + FC+ were 15.3, 28.2, and 47.0%, respectively. Urinary tract infections (P < 0.001), Pneumocystis jirovecii pneumonia (P < 0.001), and cytomegalovirus viremia (P < 0.001) were more frequent in CDC-FC+ and CDC + FC+ than in CDC-FC-.ConclusionsThis study showed that similar graft and patient survival was achieved in CDC-FC+ and CDC + FC+ KT compared with CDC-FC- through DSA-targeted desensitization despite the higher incidence of rejection and infection than that in compatible KT.

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Section: Discussionmentioning

confidence: 99%

Transplant outcomes in positive complement-dependent cytotoxicity- versus flow cytometry-crossmatch kidney transplant recipients after successful desensitization: a retrospective study

et al. 2019

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“…Also, there was no difference in the rate of ABMR comparing the DSA MFI 100-500 group (7.7%) versus the negative DSA group (4.5%) (p = . 19) or DSA MFI more than or equal to 500-1000 group (8%) versus the negative DSA group (4.5%) (p = .21). In the adjusted analysis, the low-level DSA group had a two-fold increased risk of developing ABMR compared with the DSA negative group, but this difference did not reach statistical significance (p = .07).…”

Section: Rejection Graft and Patient Outcomesmentioning

confidence: 91%

“…18 Consequently, these patients receive stronger short-and long-term immunosuppression including higher doses of maintenance therapy. 6,19,20 Patients with pretransplant DSA are at increased risk of rejection without proper immunosuppression, while at the same time, these patients may also develop infectious complications due to overimmunosuppression. In agreement with this, patients in our cohort with lowlevel and positive DSA were at increased risk of developing both ABMR and BK viremia.…”

Section: Infectious Complicationsmentioning

confidence: 99%

Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation

Parajuli

Bath

Hidalgo

et al. 2021

Immunity Inflam & Disease

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Background: The effect of low-level pretransplant donor-specific antibody (DSA) on kidney transplant outcomes is not well described. The goal of this study was to compare outcomes among patients of varying immunologic risk, based on the level of pretransplant DSA. Methods:We retrospectively reviewed all adult kidney transplant recipients who had undergone a transplant at our center between January 2013 and May 2017. Patients were grouped as negative DSA (mean fluorescence intensity, [MFI SUM < 100]), low-level DSA (MFI SUM 100-1000), and positive DSA (MFI SUM > 1000). Rejection, infection, graft, and patient survival were outcomes measured. Results: Of 952 patients, 82.1% had negative DSA, 10.7% had low-level DSA, and 7.1% had positive DSA. The positive DSA group had the highest rate of antibody-mediated rejection (10.3%), followed by low-level DSA (7.8%) and the negative DSA group (4.5%) (p = .034). The rate of BK viremia was highest in the positive DSA group (39.7%), followed by the low-level group (30.4%) and the negative DSA group (25.6%), (p = .025). None of the other outcomes, including graft or patient survival, were different between the groups. Conclusion: While low-level DSA should not prevent proceeding with kidney transplantation, it should not be ignored. Future studies are needed to investigate the long-term effects of varying levels of pre-transplant DSA on outcomes.

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“…All patients undergoing renal transplant biopsy had BK plasma PCR tested as a part of the biopsy visit. Also, BK PCR was monitored every 2 weeks for 3 months if a patient was treated for rejection …”

Section: Methodsmentioning

confidence: 99%

“…Plasma BK PCR was monitored every 2 weeks for the first 3 months post-transplant, every month for months 3-6, and every 3 months from months 6 to 12. All patients undergoing renal transplant biopsy had BK plasma PCR tested as a part of the biopsy visit.Also, BK PCR was monitored every 2 weeks for 3 months if a patient was treated for rejection 13.…”

mentioning

confidence: 99%

Outcomes in the highest panel reactive antibody recipients of deceased donor kidneys under the new kidney allocation system

Parajuli

Redfield

Astor

et al. 2017

Clinical Transplantation

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Since the institution of the new kidney allocation system in December 2014, kidney transplant candidates with the highest calculated panel reactive antibodies (cPRA) of 99-100 have been transplanted at much higher rates. However, concerns have been raised that outcomes in these patients might be impaired due to higher immunological risk and longer cold ischemia times resulting from long-distance sharing of kidneys. Here, we compare outcomes at the University of Wisconsin between study patients with cPRA 99-100 and all other recipients of deceased donor kidneys transplanted between 12/04/2014 and 12/31/2015. All patients had at least 6 months post-transplant follow-up. The mean follow-up was 13.9±3 months in cPRA ≥99% and 12.3±3.5 months in cPRA ≤98%. There was a total of 152 transplants, 25 study patients, and 127 controls. No statistically significant differences were found between the two groups in delayed graft function, rejection, kidney function, graft and patient survival, or infections. We conclude that transplanting the most highly sensitized patients with kidneys shared outside their local donation service areas is associated with excellent short-term outcomes that are comparable to controls.

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In Kidney Transplant Recipients With a Positive Virtual Crossmatch, High PRA was Associated With Lower Incidence of Viral Infections

Abstract: Although more than 40% of patients with a positive virtual crossmatch presented with BK infection/CMV disease, high PRA greater than 80% seemed to be protective.

Cited by 12 publications

References 23 publications

Transplant outcomes in positive complement-dependent cytotoxicity- versus flow cytometry-crossmatch kidney transplant recipients after successful desensitization: a retrospective study

Transplant outcomes in positive complement-dependent cytotoxicity- versus flow cytometry-crossmatch kidney transplant recipients after successful desensitization: a retrospective study

Impact of low‐level pretransplant donor‐specific antibodies on outcomes after kidney transplantation

Outcomes in the highest panel reactive antibody recipients of deceased donor kidneys under the new kidney allocation system

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