Improving HLA matching in living donor kidney transplantation using kidney paired exchange program

Tafulo, Sandra; Malheiro, Jorge; Dias, Leonídio; Lobato, Luísa; Ramalhete, Luís; Martinho, António; Bolotinha, Catarina; Costa, Rita; Ivo, Margarida

doi:10.1016/j.trim.2020.101317

Cited by 4 publications

(5 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This could be possibly overcome through the inclusion of compatible pairs in kidney-paired exchange programs, with the goal of obtaining a better HLA or eplets match. The pairing of donor and recipients through these programs increases the transplant opportunities for all patients on the waitlist and would favor highly sensitized and blood O type recipients [ 3 , 23 , 24 ]. Decreasing HLA and eplets MM, especially in class II, could improve significantly long-term survival of renal grafts as the degree of MM is associated with increased rejection rate [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…The scarcity of organs, despite the good policy of deceased organ retrieval, is a critical problem. Opting for living donation is one of the possibilities to increase organ supply, particularly from non-related donation and exchange programs [ 3 ]. The expansion of LDKT programs over the last decades was only possible because of the growth of living unrelated kidney donation (LURD), largely associated with a declining emphasis on close human leukocyte antigen (HLA) matches between donor-recipient pairs [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Greater Impact of Living Donation Than HLA Mismatching in Short-Term Renal Allograft Survival

Ribeiro¹,

Pereira²,

Oliveira³

et al. 2023

Cureus

Self Cite

View full text Add to dashboard Cite

Introduction: Living donor kidney transplantation (LDKT) is accepted as first-line treatment for patients with end-stage kidney disease with advantages over deceased donor kidney transplantation (DDKT). Still, how the known detrimental effect of HLA mismatch (MM) may hamper these advantages remains unsettled. We sought to determine the effect of the degree of HLA MM, separately in deceased and living donor renal allograft outcomes. Methods: We evaluated all adults submitted to LDKT and DDKT at our center between 2006 and 2018. Their HLA MM was classified according to the British Society of Transplantation system in low mismatch (LM) (level 1-2) and high mismatch (HM) (level 3-4). Acute rejection (AR) and global or censored graft survival were the outcomes of interest. Recipients were followed up from transplant until death, graft failure or the end of 2020. Results: One thousand sixty-eight kidney transplant recipients were analyzed, 815 (76%) received a DDKT whereas 253 (24%) received an LDKT. From those submitted to DDKT, 95 (12%) had an LM and 720 (88%) had an HM, whereas in LDKT 32 (13%) had an LM and 221 (87%) had an HM. The AR at one year was 9% in the full cohort. Significant risk factors for AR were HM DDKT (OR:2.3, P=0.047) or HM LDKT (OR:5.6, P=0.003) (LM DDKT as reference), calculated panel-reactive antibody (cPRA) ≥5% (OR:1.9, P=0.040) and delayed graft function (DGF), (OR:3.2, P<0.001). Censored graft survival (CGS) at five years was 96% in the full cohort. Independent predictors for censored graft failure (CGF) were HM LDKT (HR:0.2, P=0.046) (LM DDKT as reference), AR (HR:2.7, P=0.008) and DGF (HR:2.2, P=0.017). Global graft survival (GGS) at five years was 91% in the full cohort. Independent predictors for global graft failure (GGF) were HM LDKT (HR:0.2, P=0.042) (LM DDKT as reference), recipient age (HR:1.8, P<0.001) and DGF (HR:1.8, P=0.006). No AR, CGF or GGF episodes were observed in the LM LDKT group. Conclusions: In our cohort, the level of HLA MM increased the risk of AR independently of donor type. Considering short graft survival, our results support the advantage of living donor vs deceased donor even with an increased HLA MM. However, its effect on long-term graft survival remains to be settled, emphasizing the need for further studies on this matter.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Greater Impact of Living Donation Than HLA Mismatching in Short-Term Renal Allograft Survival

Ribeiro¹,

Pereira²,

Oliveira³

et al. 2023

Cureus

Self Cite

View full text Add to dashboard Cite

show abstract

“…A multi-center study demonstrated that 26.9% of otherwise compatible pairs enrolled in such a program and more than half successfully received an equivalent or better match [ 21 ]. Several groups have created simulations to demonstrate that HLA compatible pairs enrolled may be able to achieve significantly lower HLA class I and class II total and antibody-verified eplet mismatch load through the paired kidney donation program [ 22 ].…”

Section: Pre-transplant Measuresmentioning

confidence: 99%

Preventing Rejection of the Kidney Transplant

Malhotra,

Jethwani

2023

JCM

View full text Add to dashboard Cite

With increasing knowledge of immunologic factors and with the advent of potent immunosuppressive agents, the last several decades have seen significantly improved kidney allograft survival. However, despite overall improved short to medium-term allograft survival, long-term allograft outcomes remain unsatisfactory. A large body of literature implicates acute and chronic rejection as independent risk factors for graft loss. In this article, we review measures taken at various stages in the kidney transplant process to minimize the risk of rejection. In the pre-transplant phase, it is imperative to minimize the risk of sensitization, aim for better HLA matching including eplet matching and use desensitization in carefully selected high-risk patients. The peri-transplant phase involves strategies to minimize cold ischemia times, individualize induction immunosuppression and make all efforts for better HLA matching. In the post-transplant phase, the focus should move towards individualizing maintenance immunosuppression and using innovative strategies to increase compliance. Acute rejection episodes are risk factors for significant graft injury and development of chronic rejection thus one should strive for early detection and aggressive treatment. Monitoring for DSA development, especially in high-risk populations, should be made part of transplant follow-up protocols. A host of new biomarkers are now commercially available, and these should be used for early detection of rejection, immunosuppression modulation, prevention of unnecessary biopsies and monitoring response to rejection treatment. There is a strong push needed for the development of new drugs, especially for the management of chronic or resistant rejections, to prolong graft survival. Prevention of rejection is key for the longevity of kidney allografts. This requires a multipronged approach and significant effort on the part of the recipients and transplant centers.

show abstract

“…Even in the absence of a well-matched related donor, paired kidney exchange may improve HLA matching. [176][177][178] Taken together, there seems to be room to reduce immunological graft losses in repeat KT recipients.…”

Section: Acceptable Mismatch Programmentioning

confidence: 99%

How to Deal With Kidney Retransplantation—Second, Third, Fourth, and Beyond

Sageshima¹,

Chandar²,

Chen

et al. 2021

Transplantation

View full text Add to dashboard Cite

Kidney transplantation is the best health option for patients with end-stage kidney disease. Ideally, a kidney transplant would last for the lifetime of each recipient. However, depending on the age of the recipient and details of the kidney transplant, there may be a need for a second, third, fourth, or even more kidney transplants. In this overview, the outcome of multiple kidney transplants for an individual is presented. Key issues include surgical approach and immunologic concerns. Included in the surgical approach is an analysis of transplant nephrectomy, with indications, timing, and immunologic impact. Allograft thrombosis, whether related to donor or recipient factors merits investigation to prevent it from happening again. Other posttransplant events such as rejection, viral illness (polyomavirus hominis type I), recurrent disease (focal segmental glomerulosclerosis), and posttransplant lymphoproliferative disease may lead to the need for retransplantation. The pediatric recipient is especially likely to need a subsequent kidney transplant. Finally, noncompliance/nonadherence can affect both adults and children. Innovative approaches may reduce the need for retransplantation in the future.

show abstract

Improving HLA matching in living donor kidney transplantation using kidney paired exchange program

Cited by 4 publications

References 48 publications

Greater Impact of Living Donation Than HLA Mismatching in Short-Term Renal Allograft Survival

Greater Impact of Living Donation Than HLA Mismatching in Short-Term Renal Allograft Survival

Preventing Rejection of the Kidney Transplant

How to Deal With Kidney Retransplantation—Second, Third, Fourth, and Beyond

Contact Info

Product

Resources

About