Long-Term Graft Survival Is Improved in Cadaveric Renal Retransplantation by Flow Cytometric Crossmatching1

Bryan, Christopher; Baier, K. A.; Nelson, Paul W.; Luger, Alan M.; Martinez, John; Pierce, George E.; Ross, Gilbert; Shield, Charles F.; Warady, Bradley A.; Aeder, Mark I.; Helling, Thomas S.; Muruve, Nicolas A.

doi:10.1097/00007890-199812270-00043

Cited by 65 publications

(5 citation statements)

References 13 publications

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“…For such patients, repeat transplantation provides better long-term survival and improved quality of life compared to remaining on dialysis, although these studies have only focused on second transplants (17-19). We herein report the analysis of the UNOS experience evaluating outcomes of 3KT and we demonstrate that in selected patients, a third kidney transplant provides significant patient survival advantage over the waitlist while offering a slightly reduced graft outcome compared to first kidney transplants.…”

Section: Discussionmentioning

confidence: 99%

Graft and Patient Survival Outcomes of a Third Kidney Transplant

Redfield

Gupta²,

Rodríguez³

et al. 2015

Transplantation

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Background The waiting time for deceased donor renal transplantation in the United States continues to grow. Retransplant candidates make up a small but growing percentage of the overall transplant waiting list and raise questions about the stewardship of scarce resources. The utility of renal transplantation among individuals with two prior renal transplants is not described in the literature and we thus sought to determine the survival benefit associated with a third kidney transplant (3KT). Methods Multivariable Cox regression models were created to determine characteristics associated with 3KT outcomes and the survival benefit of 3KT among recipients wait listed and transplanted within the United States between 1995 and 2009. Results 4,334 patients were waitlisted for a 3KT and 2,492 patients received a 3KT. In a multivariate analysis, 3KT demonstrated an overall patient survival benefit compared to the wait list (HR-0.379, CI=0.302-0.475 p<0.001) for those awaiting their first, second or third kidney transplants, although an inferior graft outcome compared to first kidney transplants. The time to survival benefit did not accrue until 8-months after transplant. Additionally we found that the duration of second graft survival was predictive of third graft survival, such that second graft survival beyond 5 years is associated with superior 3KT graft survival. Second graft loss in 30 days or less was not associated with inferior 3KT graft survival. Conclusion 3KT achieves a survival benefit over remaining on the wait list, although is associated with inferior graft outcomes compared to first kidney transplants. Graft survival of the second transplant beyond 5 years is associated with superior 3KT graft survival.

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Section: Discussionmentioning

confidence: 99%

Graft and Patient Survival Outcomes of a Third Kidney Transplant

Redfield

Gupta²,

Rodríguez³

et al. 2015

Transplantation

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“…DSA present in low or even moderate amounts may not cause a positive AHG-XM and it is likely that many XM-negative recipients had DSA. Therefore it is quite probable that historically accepted risk factors such as retransplantation or increased PRA were surrogates for (unrecognized) donor specific sensitization(1, 17, 21). …”

Section: Discussionmentioning

confidence: 99%

“…Consequently the identification, characterization and to a limited degree, quantification of preformed HLA antibodies has improved, as single antigen bead (SAB) testing identifies a much lower level of antibody than required to cause a positive AHG crossmatch(1–6). …”

mentioning

confidence: 99%

Revisiting Traditional Risk Factors for Rejection and Graft Loss After Kidney Transplantation

Dunn

Noreen

Gillingham

et al. 2011

American Journal of Transplantation

187

145

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Single antigen bead (SAB) testing permits reassessment of immunologic risk for kidney transplantation. Traditionally, high panel reactive antibody (PRA), retransplant and deceased donor (DD) grafts have been associated with increased risk. We hypothesized that this risk was likely mediated by (unrecognized) donor-specific antibody (DSA). We grouped 587 kidney transplants using clinical history and SAB testing of day of transplant serum as 1) unsensitized; PRA=0 (n= 178), 2) 3rd party sensitized; no DSA (n=363), or 3) donor sensitized; with DSA (n=46), and studied rejection rates, death censored graft survival (DCGS), and risk factors for rejection. Antibody-mediated rejection (AMR) rates were increased with DSA (p<0.0001), but not with PRA in the absence of DSA. Cell-mediated rejection (CMR) rates were increased with DSA (p<0.005); with a trend to increased rates when PRA>0 in the absence of DSA (p=0.08). Multivariate analyses showed risk factors for AMR were DSA, worse HLA matching, and female gender; for CMR: DSA, PRA>0 and worse HLA matching. AMR and CMR were associated with decreased DCGS. The presence of DSA is an important predictor of rejection risk, in contrast to traditional risk factors. Further development of immunosuppressive protocols will be facilitated by stratification of rejection risk by donor sensitization.

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“…These antibodies have been traditionally detected by cytotoxicity techniques and more recently by flow cytometry [7][8][9]. Currently, solid-phase immunoassay (SPI) using coated beads with HLA antigens offers a higher level of sensitivity in the detection of anti-HLA antibodies [10 -13].…”

Section: Introductionmentioning

confidence: 99%