| Autor: |
Trijntje J. W. Rennie, Richard K. Battle, Angela A. Abel, Sylvia McConnell, Robert McLaren, Paul J. Phelan, Colin Geddes, Neal Padmanabhan, Marc J. Clancy, Ann‐Margaret Little, David M. Turner |
| Jazyk: |
angličtina |
| Rok vydání: |
2022 |
| Předmět: |
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| ISSN: |
1320-5358 |
| Popis: |
Background: \ud Reports of HLA incompatible (HLAi) kidney transplant outcomes are inconclusive, especially in the context of lower level Donor Specific Antibodies (DSA).\ud \ud Methods: \ud Multi-centre national cohort study of HLAi kidney transplant recipients matched in 1:2 ratio with HLA compatible (HLAc) kidney transplant recipients. HLAi defined as DSA identified by Luminex. Antibody mediated rejection (AMR) and transplant-survival were analysed using Kaplan-Meier plots. Propensity score (PS) matching was used to compare recipient and transplant survival between groups.\ud \ud Results: \ud We included 61 HLAi and 122 HLAc recipients; mean age 46 years; 60% female. MFIT0: 3327 (IQR 1352 – 6458), 23 (38%) were Flow cytometry crossmatch positive (FC-XMPOS). DSAPOS/FC-XMPOS transplantation carried an increased risk of AMR at 1 year (52%) compared to DSAPOS/FC-XMNEG (27%) and HLAc (0%). Unadjusted death censored graft loss at 3 years was 13% (HLAi) and 8% (HLAc). Three-year patient survival was 95% in HLAc, 84% in DSAPOS/FC-XMNEG and 69% in DSAPOS/FC-XMPOS recipients; 58% of HLAi deaths were infection-related. HLA incompatibility was associated with a decreased 3-year survival in our PS-matched cohort.\ud \ud Conclusion: \ud In kidney transplantation, DSA and positive FC-XM carries an increased risk of AMR. Despite inferior transplant and survival outcomes compared to HLAc transplantation, it remains a realistic option for highly sensitised patients facing prolonged waiting times and reduced survival on dialysis. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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