Outcome of the risk-stratified desensitization protocol in donor-specific antibody-positive living kidney transplant recipients: a retrospective study

Abstract

Acceptable outcomes of donor-specific antibody (DSA)-positive living kidney transplantation (LKT) have recently been reported. However, LKT in crossmatch (XM)-positive patients remains at high-risk and requires an optimal desensitization protocol. We report our intermediate-term outcomes of XM-positive LKT vs. XM-negative LKT in patients who underwent LKT between January 2012 and June 2015 in our institution. The rate of acute antibody-mediated rejection (ABMR) within 90 days postoperation, graft function, and patient, and graft survival rates at 4 years were investigated. Patients were divided into three groups: XM-DSA- (n = 229), XM-DSA+ (n = 36), and XM + DSA+ (n = 15). The XM + DSA+ group patients underwent desensitization with high-dose intravenous immunoglobulin, plasmapheresis, and rituximab. The rates of ABMR within 90 days in the XM-DSA-, XM-DSA+, and XM + DSA+ groups were 1.3%, 9.4%, and 60.0%, respectively (P < 0.001). There were no significant differences in the graft function throughout the observational period, the 4-year patient or graft survival rates among three groups. This study showed that intermediate-term outcomes of XM-positive LKT were comparable to XM-negative LKT. However, our current desensitization protocol cannot avert ABMR within 90 days, and XM positivity is still a significant risk factor for ABMR. Further refinement of the current desensitization regimen is required.

Influence of a low-dose tacrolimus protocol on the appearance of de novo donor-specific antibodies during 7 years of follow-up after renal transplantation

“…We evaluated a total of 994 patients who received a transplant at the Department of Urology of Tokyo Women’s Medical University between 2000 and 2015 ( Figure 1 ). Of these patients, 410 were excluded: pediatric recipients, deceased transplant recipients, extremely highly sensitized recipients such as complement-dependent cytotoxicity T-test positive and/or desensitization treatment–resistant (highly sensitized patients such as desensitization treatment–reactive patients were included [ 8 ]), recipients who did not undergo regular follow-up [regular renal biopsies and/or regular monitoring for DSAs by single-antigen bead assay (SABA)] and recipients who underwent follow-up at unknown hospitals. Thus 584 patients were included in this study.…”

Transplant outcomes in positive complement-dependent cytotoxicity- versus flow cytometry-crossmatch kidney transplant recipients after successful desensitization: a retrospective study

“…A recent multicenter study reported that the rates of readmission owing to infectious complications in both HLA-incompatible group and control subjects were virtually the same [31]. Furthermore, Okuda et al [14] reported that bacterial and viral infections were not different between the positive- and negative-crossmatch KT groups. However, our study shows that various infections such as UTIs, bacteremia, PJP, and CMV infections were significantly more prevalent in the positive-crossmatch group than in the compatible group.…”

“…A recent study reported a similar graft and patient survival rate between positive-crossmatch living-donor KT (LDKT) and compatible KT upon desensitization with a risk-stratified protocol [14]; however, the study involved a small cohort undergoing CDC-positive KT. Hence, this study aimed to evaluate post-transplant outcomes of CDC-positive (CDC + FC+) and FC-positive (CDC-FC+) KT using a DSA-targeted desensitization protocol and compare these outcomes with those of compatible KT (CDC-FC-).…”

Impact of donor‐related arteriosclerosis in pretransplant biopsy on long‐term outcome of living‐kidney transplantation: A propensity score‐matched cohort study

“…The final follow‐up evaluation of the 1351 recipients in the present study was carried out in February 2019. We described our immunosuppressive regimens elsewhere …”

“…We described our immunosuppressive regimens elsewhere. 10,11 We extracted data from the Japan Academic Consortium of Kidney Transplantation study-II (UMIN Clinical Trials Registry Number: UMIN000033449). Ethical approval of this study protocol was granted by the research ethics committee (approval number: 4460), according to the Declaration of Helsinki.…”