Kidney retransplantation from <scp>HLA</scp>‐incompatible living donors: A single‐center study of 3rd/4th transplants

Barnes, J. C.; Goodyear, Steve; Imray, C.; Lam, F. T.; Kashi, Habib; Tan, Liang; Higgins, Robert; Imray, Christopher H.E.

doi:10.1111/ctr.13104

Cited by 7 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The full-text review was undertaken for 886 eligible articles; of these 78 articles discussed HLA incompatibility at the level of the antigen mismatch only, 64-141 whereas 163 articles assessed incompatibility by molecular genotyping, molecular mismatch analysis, and/or pretransplant DSA verification by solid-phase and/or by cell-based assays. 3,142-303 The Preferred Reporting Items for Systematic reviews and Meta-Analyses diagram outlining the article selection process is provided in Figure 1. 304…”

Section: Resultsmentioning

confidence: 99%

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

et al. 2022

View full text Add to dashboard Cite

Original Clinical Science-GeneralBackground. There is no standard definition for "HLA incompatible" transplants. For the first time, we systematically assessed how HLA incompatibility was defined in contemporary peer-reviewed publications and its prognostic implication to transplant outcomes. Methods. We combined 2 independent searches of MEDLINE, EMBASE, and the Cochrane Library from 2015 to 2019. Content-expert reviewers screened for original research on outcomes of HLA-incompatible transplants (defined as allele or molecular mismatch and solid-phase or cell-based assays). We ascertained the completeness of reporting on a predefined set of variables assessing HLA incompatibility, therapies, and outcomes. Given significant heterogeneity, we conducted narrative synthesis and assessed risk of bias in studies examining the association between death-censored graft failure and HLA incompatibility. Results. Of 6656 screened articles, 163 evaluated transplant outcomes by HLA incompatibility. Most articles reported on cytotoxic/flow T-cell crossmatches (n = 98). Molecular genotypes were reported for selected loci at the allele-group level. Sixteen articles reported on epitope compatibility. Pretransplant donor-specific HLA antibodies were often considered (n = 143); yet there was heterogeneity in sample handling, assay procedure, and incomplete reporting on donor-specific HLA antibodies assignment. Induction (n = 129) and maintenance immunosuppression (n = 140) were frequently mentioned but less so rejection treatment (n = 72) and desensitization (n = 70). Studies assessing death-censored graft failure risk by HLA incompatibility were vulnerable to bias in the participant, predictor, and analysis domains. Conclusions. Optimization of transplant outcomes and personalized care depends on accurate HLA compatibility assessment. Reporting on a standard set of variables will help assess generalizability of research, allow knowledge synthesis, and facilitate international collaboration in clinical trials.

show abstract

Section: Resultsmentioning

confidence: 99%

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The 5-year recipient survival was 82.5% for first, 100% for second, and 95% for third and fourth kidney transplantation. On comparing the living donor HLA incompatible versus the deceased donor compatible third and fourth transplantations, no statistical difference was seen in the allograft survival or estimated glomerular filtration rate at any time between the 2 groups [ 29 ]. All the aforementioned studies are summarized in Table 1 .…”

Section: Discussionmentioning

confidence: 99%

Successful Third Kidney Transplant After Desensitization for Combined Human Leucocyte Antigen (HLA) and ABO Incompatibility: A Case Report and Review of Literature

et al. 2019

View full text Add to dashboard Cite

Patient: Female, 30Final Diagnosis: 3rd kidney transplantation with HLA and ABO incompatibilitySymptoms: Renal failureMedication: —Clinical Procedure: DesensitisationSpecialty: NephrologyObjective:Unusual or unexpected effect of treatmentBackground:In the present era, kidney transplantation across immunological barriers (ABO incompatibility and human leucocyte antigen (HLA) incompatibility) is a successful strategy to provide transplantation to immunologically high-risk patients. The safety and outcome of crossing both ABO and HLA barriers simultaneously in a retransplantation scenario is rarely reported from the developing world.Case Report:A 30-year-old female underwent a third living donor kidney transplantation. Her previous 2 transplants being lost to chronic allograft nephropathy. The transplantation was done across a simultaneous blood group as well as HLA incompatibility. The donor was the mother who was blood group B, with the recipient being blood group O. The complement dependent cytotoxicity crossmatch of the pair was negative but the flow cross match for T as well as B lymphocytes was positive. The mean fluorescence intensity value for class I antigens was 6951 and that for class 2 antigens was 7534. The patient underwent a desensitization procedure including rituximab, plasmapheresis and intravenous immunoglobulin pre-transplantation. The pre-transplantation isohemaglutunin titer was <1: 8 and the donor specific antibody against class 1 antigens was <2200 and <770 against class 2 antigens. Induction was done with anti-thymocyte globulin in the dose of 3 mg/kg in 2 divided doses. The patient is maintained on triple immunosuppression with tacrolimus, prednisolone and mycophenolate mofetil. After a follow-up period of 5 months, she maintains a good graft function with serum creatinine of 1.01 mg/dL.Conclusions:With the advances in the desensitizing procedures in the developing world, kidney transplantation across a combined HLA and ABO incompatible barrier can be offered to these highly sensitized patients, even in case of retransplantation.

show abstract

“…[12][13][14][15][16] As a result, some kidney transplant centers have lower kidney retransplant rates with highly selective criteria for retransplantation. 9,17,18 Nevertheless, kidney transplant patients, including recipients with kidney retransplant, are heterogeneous and there are many factors, including recipient, donor, and transplantrelated characteristics, that can result in varying outcomes. [2][3][4][5][6]19,20 Machine learning (ML), a subfield of artificial intelligence, has been applied to create clinical decision support tools and individualize patient care, including in kidney transplantation.…”

Section: Data From the United States Renal Data System And Canadianmentioning

confidence: 99%

“…However, prior studies have demonstrated an association between retransplantation and poor outcomes after kidney transplantation, including acute rejection, and reduced allograft survival, when compared to first kidney transplantation 12–16 . As a result, some kidney transplant centers have lower kidney retransplant rates with highly selective criteria for retransplantation 9,17,18 . Nevertheless, kidney transplant patients, including recipients with kidney retransplant, are heterogeneous and there are many factors, including recipient, donor, and transplant‐related characteristics, that can result in varying outcomes 2–6,19,20 …”

Section: Introductionmentioning

confidence: 99%

Differences between kidney retransplant recipients as identified by machine learning consensus clustering

Vaitla

Jadlowiec

Mao

et al. 2023

Clinical Transplantation

View full text Add to dashboard Cite

Background Our study aimed to characterize kidney retransplant recipients using an unsupervised machine‐learning approach. Methods We performed consensus cluster analysis based on the recipient‐, donor‐, and transplant‐related characteristics in 17 443 kidney retransplant recipients in the OPTN/UNOS database from 2010 to 2019. We identified each cluster's key characteristics using the standardized mean difference of >.3. We compared the posttransplant outcomes, including death‐censored graft failure and patient death among the assigned clusters Results Consensus cluster analysis identified three distinct clusters of kidney retransplant recipients. Cluster 1 recipients were predominantly white and were less sensitized. They were most likely to receive a living donor kidney transplant and more likely to be preemptive (30%) or need ≤1 year of dialysis (32%). In contrast, cluster 2 recipients were the most sensitized (median PRA 95%). They were more likely to have been on dialysis >1 year, and receive a nationally allocated, low HLA mismatch, standard KDPI deceased donor kidney. Recipients in cluster 3 were more likely to be minorities (37% Black; 15% Hispanic). They were moderately sensitized with a median PRA of 87% and were also most likely to have been on dialysis >1 year. They received locally allocated high HLA mismatch kidneys from standard KDPI deceased donors. Thymoglobulin was the most commonly used induction agent for all three clusters. Cluster 1 had the most favorable patient and graft survival, while cluster 3 had the worst patient and graft survival. Conclusion The use of an unsupervised machine learning approach characterized kidney retransplant recipients into three clinically distinct clusters with differing posttransplant outcomes. Recipients with moderate allosensitization, such as those represented in cluster 3, are perhaps more disadvantaged in the kidney retransplantation process. Potential opportunities for improvement specific to these re‐transplant recipients include working to improve opportunities to improve access to living donor kidney transplantation, living donor paired exchange and identifying strategies for better HLA matching.

show abstract

Kidney retransplantation from HLA‐incompatible living donors: A single‐center study of 3rd/4th transplants

Abstract: Background: The demand for kidney retransplantation following graft failure is rising.

Cited by 7 publications

References 27 publications

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

Successful Third Kidney Transplant After Desensitization for Combined Human Leucocyte Antigen (HLA) and ABO Incompatibility: A Case Report and Review of Literature

Differences between kidney retransplant recipients as identified by machine learning consensus clustering

Contact Info

Product

Resources

About