Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysis

Scurt, Florian G; Ewert, Lara; Mertens, Peter R.; Haller, Hermann; Schmidt, Bernhard M.W.; Chatzikyrkou, Christos

doi:10.1016/s0140-6736(18)32091-9

Cited by 107 publications

(88 citation statements)

References 82 publications

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“…Consistent with the known diminished expression of A antigen expression on A 2 cells compared to A 1 cells, titers of A 2 antibodies were always equal to (14.3%) or less than (85.7%) titers of A 1 antibodies . Importantly, it was recently reported that recipients of ABO‐incompatible kidney allografts had lower 1‐year and 3‐year posttransplant mortality compared to recipients of ABO‐compatible allografts . Continued exploration of this topic seems to be of significant interest to the medical community.…”

Section: Discussionmentioning

confidence: 58%

“…25 Importantly, it was recently reported that recipients of ABO-incompatible kidney allografts had lower 1-year and 3-year posttransplant mortality compared to recipients of ABO-compatible allografts. 26 Continued exploration of this topic seems to be of significant interest to the medical community. It should be noted, however, that the clinical value of anti-A titers measured against A 2 RBCs is unknown and that these titers are not routinely reported in the clinical literature.…”

Section: Discussionmentioning

confidence: 99%

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Isohemagglutinin titering performed on an automated solid‐phase and hemagglutinin‐based analyzer is comparable to results obtained by manual gel testing

Lally¹,

Kruse²,

Smetana³

et al. 2020

Transfusion

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BACKGROUND Isohemagglutinins (anti‐A and anti‐B) mediate hemolytic transfusion reactions, antibody‐mediated rejection of solid‐organ transplants, and delayed engraftment after stem cell transplant. However, quantification of isohemagglutinins is often labor intensive and operator dependent, limiting availability and interfacility comparisons. We evaluated an automated, solid‐phase and agglutination‐based antibody titer platform versus manual gel testing. STUDY DESIGN AND METHODS Plasma samples were obtained from 54 randomly selected patients. Titers were determined by our laboratoryʼs standard assay (manual dilution followed by manual gel testing) and were compared to results obtained on a fully automated blood bank analyzer (Galileo NEO, Immucor). The analyzer determined immunoglobulin G (IgG) antibodies using solid‐phase and immunoglobulin M (IgM) antibodies by direct hemagglutination. RESULTS Isohemagglutinin titers obtained by manual gel versus the automated assay generally (>80%) agreed within one doubling dilution, and always (100%) agreed within two dilutions. Among O samples, the gel titer and the highest titer obtained with the automated assay (either IgG or IgM) were similar in paired, nonparametric analysis (p = 0.06 for anti‐A; p = 0.13 for anti‐B). Gel titers from group A and group B patients were slightly higher than the highest titer obtained using the automated assay (p = 0.04 for group A; p = 0.009 for group B), although these differences were within the accepted error of measurement. CONCLUSION Manual and automated methodologies yielded similar isohemagglutinin titers. Separate quantification of IgM and IgG isohemagglutinins via automated titration may yield additional insight into hemolysis, graft survival after ABO‐incompatible transplantation, and red blood cell engraftment after ABO‐incompatible stem cell transplant.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Isohemagglutinin titering performed on an automated solid‐phase and hemagglutinin‐based analyzer is comparable to results obtained by manual gel testing

Lally¹,

Kruse²,

Smetana³

et al. 2020

Transfusion

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“…Although ABO-incompatible kidney transplantation is an immunological high-risk procedure due to anti-A/B antibodies, a previous study showed no significant differences in frequency of CMV infection between ABO-incompatible and ABO-compatible kidney transplant recipients [2]. However, the risk of CMV infection after ABO-incompatible kidney transplantation was significantly higher than that after ABO-compatible kidney transplantation in patients who received a non-rituximab-based desensitization protocol [17]. In our study, 3 of 7 patients who had received ABO-incompatible kidney transplantation with splenectomy and without administration of rituximab as a desensitization protocol developed very late-onset CMV disease.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Splenectomy for ABO-Incompatible Kidney Transplantation and Very Late-Onset Cytomegalovirus Disease

et al. 2020

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Introduction: Splenectomy had been previously performed in ABO-incompatible kidney transplantation to reduce the B cell pool. However, studies have shown that patients undergoing splenectomy may have a lifelong susceptibility to infection and mortality. Splenectomy may affect the incidence of cytomegalovirus (CMV) disease even at a very late stage after transplantation in ABO-incompatible recipients. Patients and Methods: Seven patients received their graft from an ABO-incompatible living donor at our institution and underwent splenectomy for B cell reduction. Among them, 3 recipients experienced very late-onset CMV disease approximately 10 years after their transplant and were enrolled in this study. Results: Very late-onset CMV disease occurred at 9 years and 9 months, 15 years, and 13 years and 5 months after transplantation, respectively. Two recipients suffered from CMV retinitis, while one experienced colitis. The age of the patients at onset of CMV disease was 69 years, 42 years, and 71 years, respectively. Conclusion: This may be the first report on very late-onset CMV disease after splenectomy in ABO-incompatible kidney transplantation. We should be aware that these recipients can experience very late-onset CMV disease even approximately 10 years after their transplant.

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“…The study population consisted of 330 adult patients (i.e., age ≥ 19 years) who underwent elective LDKT at Seoul St. Mary’s Hospital between January 2016 and December 2017. Pediatric patients (i.e., age < 19 years), those undergoing deceased-donor or ABO-incompatible KT, patients undergoing multiorgan transplantation including the kidney, and those undergoing re-transplantation were excluded from the study because these patients require various and complex immunosuppression regimens or surgical technique application [13,14,15,16,17]. Patients with defective or missing recipient and donor graft data were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Exposure to Hyperchloremia Is Associated with Poor Early Recovery of Kidney Graft Function after Living-Donor Kidney Transplantation: A Propensity Score-Matching Analysis

Park

Yun

et al. 2019

JCM

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The effects of hyperchloremia on kidney grafts have not been investigated in patients undergoing living-donor kidney transplantation (LDKT). In this study, data from 200 adult patients undergoing elective LDKT between January 2016 and December 2017 were analyzed after propensity score (PS) matching. The patients were allocated to hyperchloremia and non-hyperchloremia groups according to the occurrence of hyperchloremia (i.e., ≥110 mEq/L) immediately after surgery. Poor early graft recovery was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 during the first 48 hours after surgery. After PS matching, no significant differences in perioperative recipient or donor graft parameters were observed between groups. Although the total amount of crystalloid fluid infused during surgery did not differ between groups, the proportions of main crystalloid fluid type used (i.e., 0.9% normal saline vs. Plasma Solution-A) did. The eGFR increased gradually during postoperative day (POD) 2 in both groups. However, the proportion of patients with eGFR > 60 mL/min/1.73 m2 on POD 2 was higher in the non-hyperchloremia group than in the hyperchloremia group. In this PS-adjusted analysis, hyperchloremia was significantly associated with poor graft recovery on POD 2. In conclusion, exposure to hyperchloremia may have a negative impact on early graft recovery in LDKT.

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Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysis

Cited by 107 publications

References 82 publications

Isohemagglutinin titering performed on an automated solid‐phase and hemagglutinin‐based analyzer is comparable to results obtained by manual gel testing

Isohemagglutinin titering performed on an automated solid‐phase and hemagglutinin‐based analyzer is comparable to results obtained by manual gel testing

Splenectomy for ABO-Incompatible Kidney Transplantation and Very Late-Onset Cytomegalovirus Disease

Exposure to Hyperchloremia Is Associated with Poor Early Recovery of Kidney Graft Function after Living-Donor Kidney Transplantation: A Propensity Score-Matching Analysis

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