Non‐HLA‐matched 3rd party vascular allograft in renal transplant may lead to sensitization against donor HLA

Abstract

3rd party donor vessels are often used for vascular reconstruction in organ transplantation. While current practice ensures that 3rd party vessels are blood group matched, HLA matching to the non-intended recipient is not performed. This practice potentially sensitizes the recipient and may reduce their future chance of renal transplant from a larger pool of donors. We examined our cohort of renal transplant recipients who received non-HLA-matched 3rd party vessels for the de-novo development of donor-specific HLA antibodies. Our institution's Human Tissue Authority (HTA) blood vessel registers were examined to identify stored donor vessels and their non-intended recipients. Donor vessel HLA status was cross-referenced with the recipient HLA status. Between 2004 and 2014, five patients were identified that received 3rd party non-HLA-matched vessels for vascular reconstruction during renal transplantation. Three patients (60%) subsequently developed donor-specific HLA antibodies. These data provide evidence that use of non-HLA-matched stored 3rd party vascular grafts may lead to sensitization in the recipient. Where time permits, HLA matching should be performed to avoid this allogeneic response. Laboratories monitoring DSA should be aware of any patient receiving a non-HLA-matched 3rd party vascular graft, and recipients may benefit from increased post-transplant immunological vigilance.

Third-party vessel allografts in kidney and pancreas transplantation: Utilization, de novo DSAs, and outcomes

“…Notably, the 2 recipients of haploidentical transplants in our database were excluded from our analysis, as they did not have posttransplant serum available for review for anti‐VA DSAs. In another series of 5 patients, anti‐VA dnDSAs were documented in 3 of 5 recipients of a VA, with no immediate deleterious effects 6 . Mittal et al 12 described a case of pancreatic arterial thrombosis that was associated with anti‐VA dnDSAs.…”

“…This may be because in cases with complex arterial anatomy on the left side, the decision to pursue left donor nephrectomy may be made, as this at least circumvents the renal vein length were documented in 3 of 5 recipients of a VA, with no immediate deleterious effects. 6 Mittal et al 12 described a case of pancreatic arterial thrombosis that was associated with anti-VA dnDSAs.…”

“…HLA mismatches between the VA donor and the recipient may invoke an immunological response that contributes to adverse outcomes in the short term as well as the long term. There are a few case reports 5 and small case series 6,7 in the literature documenting the potential for donor-specific HLA antibodies (DSAs) against VAs and outcomes in abdominal transplantation. In this study, we analyze all kidney and/or pancreas transplant recipients of VAs at our institution over a 7-year period, and describe how they were utilized, how often recipients developed anti-VA DSAs, and the clinical outcomes.…”

The Leeds hand transplant programme: Review of the laboratory management of the first six cases

“…This article is protected by copyright. All rights reserved nerve cells (Meyer zu Horste, 2010) and of sensitisation against donor HLA following vascular allografting (Watson, 2016).…”