Human Leukocyte Antigen Antibody-Incompatible Renal Transplantation: Excellent Medium-Term Outcomes With Negative Cytotoxic Crossmatch

Abstract

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.

Donor-Specific Antibodies Adversely Affect Kidney Allograft Outcomes

“…Notably, mean and median age of the patients included with DSA-SPA tended to be similar to the age of their comparative cohort without DSA in each individual study. The types of donors included in these studies varied; two studies included only deceased-donor transplants, 5,10 one study included only living-donor transplants, 8 three studies included both donor types, 7,9,11 and one study did not describe the type of donors in the cohort. 6 Induction and maintenance regimens also varied widely across studies.…”

“…Gupta et al reported that no induction regimen was routinely used, whereas the other studies used antithymocyte globulin, alemtuzumab, or an IL-2 inhibitor (Table 2). [5][6][7][8][9][10][11] Two of the seven studies consistently used a steroid-free maintenance regimen, including Willicombe et al, who maintained patients on tacrolimus monotherapy. 10,11 Patel et al 8 and Verghese et al 9 maintained patients on a calcineurin inhibitor (CNI) and prednisone, whereas the Gupta, Couzi, and Higgins and colleagues used a triple-drug regimen that included a CNI, antimetabolite, and prednisone.…”

“…10,11 Patel et al 8 and Verghese et al 9 maintained patients on a calcineurin inhibitor (CNI) and prednisone, whereas the Gupta, Couzi, and Higgins and colleagues used a triple-drug regimen that included a CNI, antimetabolite, and prednisone. [5][6][7] Although the immunosuppression protocols used varied across studies, the cohorts positive and negative for DSA-SPA within each individual study received similar induction and maintenance immunosuppression regimens. No DSA-SPA-positive recipients received peri-transplant desensitization except for patients in the study by Higgins et al 7 The seven retrospective cohort studies included in our primary analysis (group 1, flow crossmatch negative) represented a total of 1119 patients, of whom 145 were DSA-SPA positive.…”

“…[5][6][7] Although the immunosuppression protocols used varied across studies, the cohorts positive and negative for DSA-SPA within each individual study received similar induction and maintenance immunosuppression regimens. No DSA-SPA-positive recipients received peri-transplant desensitization except for patients in the study by Higgins et al 7 The seven retrospective cohort studies included in our primary analysis (group 1, flow crossmatch negative) represented a total of 1119 patients, of whom 145 were DSA-SPA positive. [5][6][7][8][9][10][11] We excluded Couzi and colleagues' study from the analysis because no rejection episodes occurred in either comparison group during the follow-up period ( Figure 2).…”

“…[5][6][7][8][9][10][11] All seven studies were retrospective cohort studies; three were from the United States and four from Europe. Our ability to compare certain patient characteristics and immunosuppression protocols across studies was limited by the variable reporting of these characteristics in the included reports.…”