Long-term outcomes of eculizumab-treated positive crossmatch recipients: Allograft survival, histologic findings, and natural history of the donor-specific antibodies
| Autor: | Mark D. Stegall, Carrie A. Schinstock, Andrew Bentall, Lynn D. Cornell, Matthew J Everly, Byron H. Smith, Manish J. Gandhi |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Time Factors medicine.medical_treatment 030230 surgery Antibodies Monoclonal Humanized Kidney Gastroenterology 03 medical and health sciences 0302 clinical medicine HLA Antigens Isoantibodies Internal medicine Statistical significance medicine Humans Immunology and Allergy Pharmacology (medical) Retrospective Studies B-Lymphocytes Transplantation biology business.industry Complement C1q Histocompatibility Testing Graft Survival Retrospective cohort study Middle Aged Eculizumab Allografts Kidney Transplantation Tissue Donors Histocompatibility Natural history Complement Inactivating Agents Treatment Outcome Case-Control Studies biology.protein Female Plasmapheresis Antibody business medicine.drug |
| Zdroj: | American Journal of Transplantation. 19:1671-1683 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.15175 |
| Popis: | We aimed to determine the long-term outcomes of eculizumab-treated, positive crossmatch (+XM) kidney transplant recipients compared with +XM and age-matched negative crossmatch (-XM) controls. We performed an observational retrospective study and examined allograft survival, histologic findings, long-term B-cell flow cytometric XM (BFXM), and allograft-loss-associated factors. The mean (SD) posttransplant follow-up was 6.3 (2.5) years in the eculizumab group; 7.6 (3.5), +XM control group; 7.9 (2.5), -XM control group. The overall and death-censored allograft survival rates were similar in +XM groups (P = .73, P = .48) but reduced compared with -XM control patients (P < .001, P < .001). In the eculizumab-treated group, 57.9% (11/19) of the allografts had chronic antibody-mediated rejection, but death-censored allograft survival was 76.6%, 5 years; 75.4%, 7 years. Baseline IgG3 positivity and BFXM ≥300 were associated with allograft loss. C1q positivity was also associated with allograft loss but did not reach statistical significance. Donor-specific antibodies appeared to decrease in eculizumab-treated patients. After excluding patients with posttransplant plasmapheresis, 42.3% (9/21) had negative BFXMs; 31.8% (7/22), completely negative single-antigen beads 1 year posttransplant. Eculizumab-treated +XM patients had reduced allograft survival compared with -XM controls but similar survival to +XM controls. BFXM and complement-activating donor-specific antibodies (by IgG3 and C1q testing) may be used for risk stratification in +XM transplantation. |
| Databáze: | OpenAIRE |
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