Transplantation Results of Completely HLA-Mismatched Living and Completely HLA-Matched Deceased-Donor Kidneys Are Comparable

Laging, M.; Gestel, Judith A. Kal-van; Haasnoot, Geert W.; Claas, Frans H.J.; Wetering, Jacqueline van de; IJzermans, Jan N. M.; Weimar, Willem; Roodnat, Joke I.

doi:10.1097/01.tp.0000435703.61642.43

Cited by 21 publications

(22 citation statements)

References 17 publications

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“…In addition, the difference in impact of DSAs on graft survival between living and deceased donor transplant is likely not due to difference in either DSA strength (Table S7a) or immunization status, as there was no stronger effect of DSAs on graft survival in patients retransplanted with a living donor kidney, than in patients receiving a living donor kidney as first transplant with a much lower level of immunization (Table S8; Figure S1; Figure S4). However, it is known that graft survival rates of poorly HLA‐matched living donor grafts are superior to those of well HLA‐matched deceased donor grafts 16, 32. This can partially be explained by the prolonged CIT in deceased donors but also by inherent factors of the organ due to cardiovascular instability of the donor before nephrectomy, who may play a role 33.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that graft survival rates in patients who received a living donor kidney are higher than the rates in recipients of a deceased donor kidney 16. While recent large‐cohort studies of the impact of DSAs on graft survival have mainly focused on deceased donor transplants,17, 18, 19 the effect of SAB assay–detected DSAs on living donor transplants has not been studied in large cohorts.…”

Section: Introductionmentioning

confidence: 99%

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Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Kamburova

Wisse

Joosten

et al. 2018

American Journal of Transplantation

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The presence of donor‐specific anti‐HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long‐term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement‐dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10‐year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10‐year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10‐year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Kamburova

Wisse

Joosten

et al. 2018

American Journal of Transplantation

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“…Panel reactive antibody (PRA) best describes the degree of immunization and in multivariable analysis high levels are associated with graft failure censored for death. In multivariable analysis, the number of preceding renal transplants does not influence graft survival when PRA is present in the model (2).…”

Section: Introductionmentioning

confidence: 99%

Kidney Retransplantation in the Ipsilateral Iliac Fossa: A Surgical Challenge

Ooms

Roodnat

Dor

et al. 2015

American Journal of Transplantation

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The aim of this study is to review the surgical outcome of kidney retransplantation in the ipsilateral iliac fossa in comparison to first kidney transplants. The database was screened for retransplantations between 1995 and 2013. Each study patient was matched with 3 patients with a first kidney transplantation. Just for graft and patient survival analyses, we added an extra control group including all patients receiving a second transplantation in the contralateral iliac fossa. We identified 99 patients who received a retransplantation in the ipsilateral iliac fossa. There was significantly more blood loss and longer operative time in the retransplantation group. The rate of vascular complications and graft nephrectomies within 1 year was significantly higher in the study group. The graft survival rates at 1 year and 3, 5, and 10 years were 76%, 67%, 61%, and 47% in the study group versus 94%, 88%, 77%, and 67% (p < 0.001) in the first control group versus 91%, 86%, 78%, and 57% (p ¼ 0.008) in the second control group. Patient survival did not differ significantly between the groups. Kidney retransplantation in ipsilateral iliac fossa is surgically challenging and associated with more vascular complications and graft loss within the first year after transplantation. Whenever feasible, the second renal transplant (first retransplant) should be performed contralateral to the prior failed one.

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“…Thus, the authors concluded that it is difficult to justify preferentially waiting for a well HLA‐matched DD kidney if there is an LD kidney available for transplantation, regardless of the level of HLA matching in the LD kidney. Furthermore, it has been shown in adults that the relative risk of graft failure of a fully mismatched LD kidney is comparable with that of a fully matched DD kidney …”

Section: Discussionmentioning

confidence: 99%

“…Secondly, potential LDs for pediatric patients are sometimes re- Furthermore, it has been shown in adults that the relative risk of graft failure of a fully mismatched LD kidney is comparable with that of a fully matched DD kidney. 23 The ultimate goal is clearly to achieve well HLA-matched LD kidney transplants for children, because these have the best renal allograft survival outcomes and produce the best long-term outcomes for patients. Further research is required to assess the impact of kidney waiting time on patient outcomes and the potential long-term consequences of poor HLA matching with implications for re-transplantation in children and adolescents due to HLA sensitization.…”

Section: Discussionmentioning

confidence: 99%

The choice between deceased‐ vs living‐donor renal transplantation in children: Analysis of data from a Belgian tertiary center

Cauwenberghe

Raes

Pauwels

et al. 2018

Pediatric Transplantation

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Pediatric renal transplantation with a living donor (LD) has superior outcome, but there is a paucity of studies analyzing the reasons for not undertaking living donation in West-European countries. The aim of this study was to retrospectively review the choice of donor source in our center. We also aimed to identify factors which prevented transplantation with a LD. This retrospective study was performed including children aged 2-19 years who underwent kidney transplantation (KT) at the Ghent University Hospital between 1996 and 2016. Relevant data were collected from medical files to identify the main medical, psychological, and socio-economic factors influencing the choice of the donor source. There were 48 patients (boys n = 33) who underwent KT. Thirty-nine patients received a deceased donor (DD) kidney and nine patients received a LD kidney. Sixteen of 48 transplantations were preemptive. The reasons for DD KT included socio-economic factors such as single caregiver families, one or both parents with a criminal record or convictions and religious or cultural constraints (n = 15), medical considerations (n = 13), refusal of the close relatives/parents to donate (n = 7), and acceptance of an organ from a DD while prospective donor was undergoing medical screening (n = 4). The low incidence of living kidney donation can be explained by socio-economic and medical factors. Refusal to donate is a potentially modifiable factor and strategies aimed at education and guidance of the families might contribute to a higher incidence of living donation in our setting.

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Transplantation Results of Completely HLA-Mismatched Living and Completely HLA-Matched Deceased-Donor Kidneys Are Comparable

Cited by 21 publications

References 17 publications

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Kidney Retransplantation in the Ipsilateral Iliac Fossa: A Surgical Challenge

The choice between deceased‐ vs living‐donor renal transplantation in children: Analysis of data from a Belgian tertiary center

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