Excellent outcome after desensitization in high immunologic risk kidney transplantation


Autoři: Jeong-Hoon Lim aff001;  Jang-Hee Cho aff001;  Hee-Yeon Jung aff001;  Ji-Young Choi aff001;  Sun-Hee Park aff001;  Yong-Lim Kim aff001;  Hyung-Kee Kim aff002;  Seung Huh aff002;  Eun Sang Yoo aff003;  Dong-Il Won aff004;  Chan-Duck Kim aff001
Působiště autorů: Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea aff001;  Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea aff002;  Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea aff003;  Department of Clinical Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222537

Souhrn

Introduction

HLA-incompatible (HLAi) and ABO-incompatible (ABOi) kidney transplantation (KT) has been on the increase over the last decade. However, there are wide variations in outcomes from these procedures. In this study we evaluated the graft and patient outcomes in incompatible KT and non-sensitized KT.

Methods

Patients who underwent KT between January 2012 and April 2018 were enrolled and reviewed. We divided kidney transplant recipients (KTRs) into five groups as follows: HLAi (n = 50); ABOi (n = 65); HLAi+ABOi (n = 5); control (n = 428); and living-donor control (LD control, n = 218). We compared the risk of rejection, graft function, graft survival, and patient survival between incompatible KTRs and control/LD control KTRs.

Results

Although the incidence of active antibody-mediated rejection in HLAi group tends to be higher than in control and LD control groups (6.0% vs. 2.8%, P = 0.20; 6.0% vs. 3.7%, P = 0.44, respectively), the rejection-free survival, graft survival, and patient survival were not significantly different from those of the control and LD control groups in all three incompatible KT groups (all P>0.05). Graft function during the study period was also not different between incompatible KTRs and control/LD control groups (both P>0.05). Using Cox regression analysis, neither HLAi nor ABOi were risk factors for graft failure. Some infectious diseases such as urinary tract infection and cytomegalovirus infection were more common in the HLAi group than in the control/LD control group (both P<0.05), but only one infection-related death occurred in HLAi KTRs. Infection risks were similar in the ABOi and HLAi+ABOi groups compared to controls.

Conclusion

Our results showed favorable outcomes for incompatible KT after desensitization. Although desensitization therapy for incompatible KT has improved access to transplantation for KT candidates with high immunological risk, more clinical data are clearly needed.

Klíčová slova:

B cells – Cytomegalovirus infection – Medical risk factors – Renal transplantation – T cells – Urinary tract infections – Graft survival – Transplant rejection


Zdroje

1. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725–30. doi: 10.1056/NEJM199912023412303 10580071.

2. Port FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993;270(11):1339–43. 8360969.

3. Jeon HJ, Bae HJ, Ham YR, Choi DE, Na KR, Ahn MS, et al. Outcomes of end-stage renal disease patients on the waiting list for deceased donor kidney transplantation: A single-center study. Kidney Res Clin Pract. 2019;38(1):116–23. Epub 2019/02/12. doi: 10.23876/j.krcp.18.0068 30743320.

4. Chung BH, Choi BS, Oh EJ, Park CW, Kim JI, Moon IS, et al. Clinical impact of the baseline donor-specific anti-human leukocyte antigen antibody measured by Luminex single antigen assay in living donor kidney transplant recipients after desensitization therapy. Transpl Int. 2014;27(1):49–59. Epub 2013/10/15. doi: 10.1111/tri.12199 24118413

5. Haririan A, Nogueira J, Kukuruga D, Schweitzer E, Hess J, Gurk-Turner C, et al. Positive cross-match living donor kidney transplantation: longer-term outcomes. Am J Transplant. 2009;9(3):536–42. Epub 2009/02/05. doi: 10.1111/j.1600-6143.2008.02524.x 19191764.

6. Marfo K, Lu A, Ling M, Akalin E. Desensitization protocols and their outcome. Clin J Am Soc Nephrol. 2011;6(4):922–36. Epub 2011/03/29. doi: 10.2215/CJN.08140910 21441131.

7. Couzi L, Manook M, Perera R, Shaw O, Ahmed Z, Kessaris N, et al. Difference in outcomes after antibody-mediated rejection between abo-incompatible and positive cross-match transplantations. Transpl Int. 2015;28(10):1205–15. Epub 2015/06/23. doi: 10.1111/tri.12621 26095452.

8. Ko EJ, Yu JH, Yang CW, Chung BH. Clinical outcomes of ABO- and HLA-incompatible kidney transplantation: a nationwide cohort study. Transpl Int. 2017;30(12):1215–25. Epub 2017/05/12. doi: 10.1111/tri.12979 28493630.

9. Chung BH, Joo YY, Lee J, Kim HD, Kim J-I, Moon IS, et al. Impact of ABO Incompatibility on the Development of Acute Antibody-Mediated Rejection in Kidney Transplant Recipients Presensitized to HLA. PLoS One. 2015;10(4):e0123638. doi: 10.1371/journal.pone.0123638 25897756.

10. Zhang X, Reed EF. Effect of Antibodies on Endothelium. Am J Transplant. 2009;9(11):2459–65. doi: 10.1111/j.1600-6143.2009.02819.x 19775314.

11. Lee KH, Won DI, Yook JM, Kim KY, Park SM, Park JH, et al. Distribution of Anti-ABO Immunoglobulin G Subclass and C1q Antibody in ABO-incompatible Kidney Transplantation. Transplant Proc. 2018;50(4):1063–7. Epub 2018/05/08. doi: 10.1016/j.transproceed.2018.01.048 29731066.

12. Alheim M, Wennberg L, Wikström A-C. Pronase independent flow cytometry crossmatching of rituximab treated patients. Human Immunology. 2018;79(2):132–5. doi: 10.1016/j.humimm.2017.11.006 29157993.

13. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. Epub 2009/05/06. doi: 10.7326/0003-4819-150-9-200905050-00006 19414839.

14. Haas M. The Revised (2013) Banff Classification for Antibody-Mediated Rejection of Renal Allografts: Update, Difficulties, and Future Considerations. Am J Transplant. 2016;16(5):1352–7. doi: 10.1111/ajt.13661 26696524.

15. Irish WD, Ilsley JN, Schnitzler MA, Feng S, Brennan DC. A Risk Prediction Model for Delayed Graft Function in the Current Era of Deceased Donor Renal Transplantation. Am J Transplant. 2010;10(10):2279–86. doi: 10.1111/j.1600-6143.2010.03179.x 20883559.

16. Dall A, Hariharan S. BK virus nephritis after renal transplantation. Clin J Am Soc Nephrol. 2008;3 Suppl 2(Suppl 2):S68–S75. doi: 10.2215/CJN.02770707 18309005.

17. Kong JM, Ahn J, Park JB, Chung BH, Yang J, Kim JK, et al. ABO incompatible living donor kidney transplantation in Korea: highly uniform protocols and good medium-term outcome. Clin Transplant. 2013;27(6):875–81. Epub 2013/10/15. doi: 10.1111/ctr.12249 24118271.

18. Uchida J, Machida Y, Iwai T, Naganuma T, Kitamoto K, Iguchi T, et al. Desensitization protocol in highly HLA-sensitized and ABO-incompatible high titer kidney transplantation. Transplant Proc. 2010;42(10):3998–4002. Epub 2010/12/21. doi: 10.1016/j.transproceed.2010.09.043 21168610.

19. Gloor JM, DeGoey SR, Pineda AA, Moore SB, Prieto M, Nyberg SL, et al. Overcoming a positive crossmatch in living-donor kidney transplantation. Am J Transplant. 2003;3(8):1017–23. Epub 2003/07/16. 12859539.

20. Yoon HE, Hyoung BJ, Hwang HS, Lee SY, Jeon YJ, Song JC, et al. Successful renal transplantation with desensitization in highly sensitized patients: a single center experience. J Korean Med Sci. 2009;24 Suppl:S148–55. Epub 2009/02/12. doi: 10.3346/jkms.2009.24.S1.S148 19194545.

21. Montgomery JR, Berger JC, Warren DS, James NT, Montgomery RA, Segev DL. Outcomes of ABO-incompatible kidney transplantation in the United States. Transplantation. 2012;93(6):603–9. Epub 2012/02/01. 22290268.

22. Gordon EJ, Ladner DP, Caicedo JC, Franklin J. Disparities in kidney transplant outcomes: a review. Semin Nephrol. 2010;30(1):81–9. Epub 2010/02/02. doi: 10.1016/j.semnephrol.2009.10.009 20116652.

23. Gordon EJ, Caicedo JC. Ethnic advantages in kidney transplant outcomes: the Hispanic Paradox at work? Nephrol Dial Transplant. 2008;24(4):1103–9. doi: 10.1093/ndt/gfn691 19075197.

24. Garcia-Garcia G, Harden P, Chapman J. The global role of kidney transplantation. Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia. 2012;32(1):1–6. Epub 2012/02/02. 22293997.

25. Massad MG, Cook DJ, Schmitt SK, Smedira NG, McCarthy JF, Vargo RL, et al. Factors influencing HLA sensitization in implantable LVAD recipients. Ann Thorac Surg. 1997;64(4):1120–5. Epub 1997/11/14. doi: 10.1016/s0003-4975(97)00807-2 9354538.

26. Saito PK, Yamakawa RH, Aparecida EP, d Silva Júnior WV, Borelli SD. Evaluation of the Humoral Immune Response to Human Leukocyte Antigens in Brazilian Renal Transplant Candidates. PLoS One. 2014;9(6):e100270. doi: 10.1371/journal.pone.0100270 24927116.

27. Ingsathit A, Kantachuvesiri S, Rattanasiri S, Avihingsanon Y, Premasathian N, Pongskul C, et al. Long-term Outcome of Kidney Retransplantation in Comparison With First Kidney Transplantation: A Report From the Thai Transplantation Registry. Transplant Proc. 2013;45(4):1427–30. doi: 10.1016/j.transproceed.2012.08.029 23726588.

28. Padmanabhan A, Ratner LE, Jhang JS, Duong JK, Markowitz GS, Vasilescu ER, et al. Comparative outcome analysis of ABO-incompatible and positive crossmatch renal transplantation: a single-center experience. Transplantation. 2009;87(12):1889–96. doi: 10.1097/TP.0b013e3181a76ae1 19543070.

29. Milland J, Sandrin MS. ABO blood group and related antigens, natural antibodies and transplantation. Tissue antigens. 2006;68(6):459–66. doi: 10.1111/j.1399-0039.2006.00721.x 17176435.

30. Padmanabhan A, Ratner LE, Jhang JS, Duong JK, Markowitz GS, Vasilescu ER, et al. Comparative outcome analysis of ABO-incompatible and positive crossmatch renal transplantation: a single-center experience. Transplantation. 2009;87(12):1889–96. Epub 2009/06/23. doi: 10.1097/TP.0b013e3181a76ae1 19543070.

31. Montgomery RA, Lonze BE, King KE, Kraus ES, Kucirka LM, Locke JE, et al. Desensitization in HLA-Incompatible Kidney Recipients and Survival. N Engl J Med. 2011;365(4):318–26. doi: 10.1056/NEJMoa1012376 21793744.

32. Takahashi K, Saito K, Takahara S, Okuyama A, Tanabe K, Toma H, et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan. Am J Transplant. 2004;4(7):1089–96. Epub 2004/06/16. doi: 10.1111/j.1600-6143.2004.00464.x 15196066.

33. Tyden G, Donauer J, Wadstrom J, Kumlien G, Wilpert J, Nilsson T, et al. Implementation of a Protocol for ABO-incompatible kidney transplantation—a three-center experience with 60 consecutive transplantations. Transplantation. 2007;83(9):1153–5. Epub 2007/05/15. doi: 10.1097/01.tp.0000262570.18117.55 17496528.

34. Opelz G, Morath C, Süsal C, Tran TH, Zeier M, Döhler B. Three-year outcomes following 1420 ABO-incompatible living-donor kidney transplants performed after ABO antibody reduction: results from 101 centers. Transplantation. 2015;99(2):400–4. doi: 10.1097/TP.0000000000000312 25050471.

35. Barnett ANR, Manook M, Nagendran M, Kenchayikoppad S, Vaughan R, Dorling A, et al. Tailored desensitization strategies in ABO blood group antibody incompatible renal transplantation. Transplant Int. 2014;27(2):187–96. Epub 2013/12/28. doi: 10.1111/tri.12234 24188566.


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