Higgins, Robert, Lowe, David, Hathaway, Mark, Williams, Clare, Lam, For T., Kashi, Habib, Tan, Lam Chin, Imray, C. (Chris), Fletcher, Simon, Chen, Klaus, Krishnan, Nithya, Hamer, Rizwan, Daga, Sunil, Edey, Matthew, Zehnder, Daniel and Briggs, David. (2011) Human leukocyte antigen antibody-incompatible renal transplantation : excellent medium-term outcomes with negative cytotoxic crossmatch. Transplantation, Vol.92 (No.8). pp. 900-906. ISSN 0041-1337

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Abstract

Background. Human leukocyte antigen (HLA) antibody-incompatible renal transplantation has been increasingly performed since 2000 but with few data on the medium-term outcomes.

Methods. Between 2003 and 2011, 84 patients received renal transplants with a pretreatment donor-specific antibody (DSA) level of more than 500 in a microbead assay. Seventeen patients had positive complement-dependent cytotoxic (CDC) crossmatch (XM), 44 had negative CDC XM and positive flow cytometric XM, and 23 had DSA detectable by microbead only. We also reviewed 28 patients with HLA antibodies but no DSA at transplant. DSAs were removed with plasmapheresis pretransplant, and patients did not routinely receive antithymocyte globulin posttransplant.

Results. Mean follow-up posttransplantation was 39.6 (range 2-91) months. Patient survival after the first year was 93.8%. Death-censored graft survival at 1, 3, and 5 years was 97.5%, 94.2%, and 80.4%, respectively, in all DSA+ve patients, worse at 5 years in the CDC+ve than in the CDC-ve/DSA+ve group at 45.6% and 88.6%, respectively (P < 0.03). Five-year graft survival in the DSA+ve group was 82.1%. Rejection occurred in 53.1% of DSA+ve patients in the first year compared with 22% in the DSA+ve patients (P < 0.003).

Conclusions. HLA antibody-incompatible renal transplantation had a high success rate if the CDC XM was negative. Further work is required to predict which CDC+ve XM grafts will be successful and to treat slowly progressive graft damage because of DSA in the first few years after transplantation.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Translational & Systems Medicine > Metabolic and Vascular Health Faculty of Medicine > Warwick Medical School
Journal or Publication Title:	Transplantation
Publisher:	Lippincott Williams & Wilkins
ISSN:	0041-1337
Official Date:	2011
Volume:	Vol.92
Number:	No.8
Number of Pages:	7
Page Range:	pp. 900-906
Identification Number:	10.1097/TP.0b013e31822dc38d
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	NHS
URI:	http://wrap.warwick.ac.uk/id/eprint/39658

Data sourced from Thomson Reuters' Web of Knowledge

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