Kidney Transplantation Across a Positive Crossmatch: A Single-Center Experience

Santos, Clara; Costa, Rui Miguel; Malheiro, Jorge; Pedroso, Sofía; Almeida, Manuela; Martins, La Salete; Dias, L.; Tafulo, Sandra; Henriques, António Castro; Cabrita, António

doi:10.1016/j.transproceed.2014.05.012

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…HLA incompatible KT in previously sensitized recipients has become increasingly popular because of the organ donor shortage in the past decade. [15] Montgomery et al [16] showed that LDKTs in patients with donor-specific HLA-Ab after desensitization provided a significant survival benefit as compared to waiting for a compatible organ. Our PS rate in patients with positive FCXM were 100.0% at 1 year and 96.6% at 3years, as compared with the rates of 92.0% and 79.9%, respectively, in the positive FCXM patients in the study of Montgomery et al The overall PS, GS, death censored GS, and rejection free GS in FCXM positive KT showed no significant differences in comparison with the FCXM negative group.…”

Section: Discussionmentioning

confidence: 99%

Analysis of 4000 kidney transplantations in a single center

et al. 2016

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Kidney transplant (KT) is the optimal renal replacement therapy for patients with end-stage renal disease (ESRD). The demand for kidneys, however, continues to exceed the supply. To overcome this problem, efforts to extend the donor pool by including human leukocyte antigen (HLA)- and ABO-incompatible (ABOi) KTs are increasing. The aim of this article was to retrospectively review data on recipients, donor profiles, and clinical outcomes in 4000 cases of KT. In addition, we analyzed clinical outcomes in ABOi and flow-cytometric crossmatch (FCXM) positive KT in a subgroup analysis.This was a retrospective, observational study using data extracted from medical records. A total of 4000 consecutive patients who underwent KT at our institution from January 1990 to February 2015 were included in this study. KTs across immunological barriers such as ABO incompatible (276 cases, 6.9%), FCXM positive (97 cases, 2.4%), and positive complement-dependent cytotoxicity (CDC) XM KT (16 cases, 0.4%) were included.From a Kaplan–Meier analysis, overall patient survival (PS) rates after KT at 1, 5, 10, and 20 years were 96.9%, 95.1%, 92.0%, and 88.9%, respectively. The overall graft survival (GS) rates after KT at 1, 5, 10, and 20 years were 96.3%, 88.9%, 81.2%, and 67.4%, respectively. Our subgroup analysis suggested that overall PS, GS, death-censored GS, and rejection-free GS in ABOi KT showed no significant differences in comparison with ABO-compatible KT if adequate immunosuppressive treatment was performed. The overall PS rate in patients who underwent FCXM positive KT did not differ significantly from that of the control group during the 3-year follow-up (P = 0.34). The overall GS, death-censored GS, and rejection-free GS also did not differ significantly between the FCXM KT and control groups (P = 0.99, 0.42, and 88).The outcomes of KTs continually improved during the study period, while the annual number of KTs increased. ABO or FCXM positive KTs can be performed safely with successful graft outcomes.

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Section: Discussionmentioning

confidence: 99%

Analysis of 4000 kidney transplantations in a single center

et al. 2016

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“…Si comparamos con nuestra serie, es evidente que el porcentaje de nuestros pacientes altamente sensibilizados están destinados a permanecer en lista de espera por periodos más prolongados (18) . Los sujetos con cualquier nivel de sensibilización son difíciles de acceder con éxito a un trasplante renal (26)(27)(28) . Por ello reciben puntos adicionales en los sistemas de asignación en algunos centros de trasplante, para compensar su desventaja biológica (27,44,45) , priorizando el acceso al trasplante.…”

Section: Discussionunclassified

Trasplante renal grupo sanguíneo ABO incompatible. Experiencia colaborativa inédita España y Perú

et al. 2017

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Resumen La incompatibilidad de grupo sanguíneo ABO y la sensibilización al HLA constituyen grandes barreras a vencer en pro de la óptima utilización de riñones de donante vivo. Describimos en nuestro medio el primer trasplante renal exitoso ABO incompatible en un paciente de 24 años, retrasplantado renal, altamente sensibilizado (PRA: 89%) y sin opción alguna en disponer de donantes cadavéricos ni familiares. Sin embargo, su único donante vivo HLA compatible era de grupo sanguíneo A incompatible con el grupo O del receptor. El paciente requirió de un régimen precondicionante consistente en recambios plasmáticos, rituximab, imunoglobulina y terapia inmunosupresora cuádruple, a fin de reducir los títulos elevados de isoaglutininas anti A de 1:128 a niveles de seguridad de 1:8, para el éxito del trasplante. Este fue realizado en Coordinación con la Unidad de Trasplante Renal del Hospital Clínic de Barcelona España (HCB). La ausencia de rechazo mediado por isoaglutininas muestra el potencial beneficio del protocolo al remover los anticuerpos anti grupo sanguíneo. A los dos años del trasplante, la función renal se mantiene estable con niveles de creatinina 1,5 mg%. Concluimos que el trasplante renal ABO incompatible (ABOi) es opción viable para pacientes cuyo único donante sea grupo sanguíneo incompatible, y entre nosotros representa esperanzadora fuente de órganos. Palabras clave: ABO Incompatible; Trasplante Renal; Acomodación; Anticuerpos anti HLA; Riesgo Inmunológico. Abstract ABO blood group incompatibility and HLA sensitization are major barriers that need to be overcome in order to make optimum use of kidneys from living donors possible. We report the first successful ABOincompatible kidney transplant in a 24-year old, highly sensitized (panel reactive antibodies (PRA) 89% kidney retransplantation patient, who lacked any option to get a cadaveric or family donor. However, the patient's sole HLA-compatible living donor had group A blood incompatible with the recipient's O blood group. The patient required a pre-conditioning regime that consisted of plasma exchange, rituximab, immunoglobulin, and quadruple immunosuppressive therapy in order to reduce high titers of anti-A isoagglutinins from 1:128 to a safe level of 1:8, for successful transplant. This was performed in coordination with the Renal Transplant Unit of Hospital Clinic de Barcelona (HCB), Spain. Absence of rejection mediated by isoagglutinins shows the potential benefit of a protocol consisting in removing antibodies from the anti-blood group. Two years after transplantation, the kidney function remains stable, with creatinine levels of 1.5 mg%. We conclude that an ABO-incompatible kidney transplant is a viable option for patients whose only donor has blood of an incompatible blood group and for us this represents a hope-inspiring source of organs.

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“…Kidney transplantation is considered the treatment of choice for patients with end‐stage kidney disease, providing better mortality outcome and quality of life compared with dialysis 1,2 …”

Section: What Is Known and Objectivementioning

confidence: 99%

Comparing safety of proton‐pump inhibitors versus H2‐receptor antagonists in kidney transplant recipients: A systematic review and meta‐analysis

Mohammadi

Yaribash

Razi

et al. 2021

Clinical Pharmacy Therapeu

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What is known and objective: Multiple studies have been conducted to compare the safety of proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs) as acidsuppressive treatment in kidney transplant recipients with conflicting results. This systematic review and meta-analysis aimed to evaluate the risk of adverse effects in kidney transplant patients receiving PPIs compared to those treated with H2RAs. Methods:A systematic search was performed on the databases from inception to June 2021. The treatment effects were expressed as odds ratio (OR), weighted mean differences (WMD) and their 95% confidence intervals (CI) and pooled by a randomeffects model. Results and Discussions:Eight studies, consisting 4,844 patients, were included.

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Kidney Transplantation Across a Positive Crossmatch: A Single-Center Experience

Cited by 11 publications

References 15 publications

Analysis of 4000 kidney transplantations in a single center

Analysis of 4000 kidney transplantations in a single center

Trasplante renal grupo sanguíneo ABO incompatible. Experiencia colaborativa inédita España y Perú

Comparing safety of proton‐pump inhibitors versus H2‐receptor antagonists in kidney transplant recipients: A systematic review and meta‐analysis

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