Risk factors for acute rejection in renal transplant recipients experiencing delayed graft function

Moore, Jason H.; Tan, Kay; Cockwell, Paul; Krishnan, Hari B.; McPake, Dawn; Ready, Andrew; Mellor, Steve; Hamsho, Ahmed; Ball, Simon; Lipkin, Graham; Borrows, Richard

doi:10.1111/j.1399-0012.2008.00837.x

Cited by 12 publications

(8 citation statements)

References 40 publications

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“…29 The increasing use of older, more marginal kidneys may heighten the risk of acute rejection in the setting of DGF because of their potential for greater immunogenicity. 30 More recent studies have examined non-invasive approaches for diagnosing acute rejection in patients with DGF, 31 risk factors for acute rejection among patients with DGF, 32 and the effect modifying the role of DCD on the DGF-acute rejection association. 13 All of these studies had small sample sizes (o100), and they did not assess the relation between DGF and acute rejection as their primary study question.…”

Section: Discussionmentioning

confidence: 99%

Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation

Famure

et al. 2015

Kidney International

179

143

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Delayed graft function (DGF) is commonly considered a risk factor for acute rejection, although this finding has not been uniformly observed across all studies. The link between DGF and acute rejection may have changed over time due to advances in immunosuppression and medical management. Here we conducted a cohort study of 645 patients over 12 years to evaluate the association of DGF and biopsy-proven acute rejection (BPAR) in a modern cohort of kidney transplant recipients. DGF was defined as the need for at least one dialysis session in the first week after kidney transplantation. The 1-, 3-, and 5-year cumulative probabilities of BPAR were 16.0, 21.8, and 22.6% in the DGF group, significantly different from the 10.1, 12.4, and 15.7% in the non-DGF group. In multivariable Cox proportional hazards model, the adjusted relative hazard for BPAR in DGF (vs. no DGF) was 1.55 (95% confidence interval (CI): 1.03, 2.32). This association was generally robust to different definitions of DGF. The relative hazard was also similarly elevated for T-cell- or antibody-mediated BPAR (1.52 (0.92, 2.51) and 1.54 (0.85, 2.77), respectively). Finally, the association was consistent across clinically relevant subgroups. Thus DGF remains an important risk factor for BPAR in a contemporary cohort of kidney transplant recipients. Interventions to reduce the risk of DGF and/or its aftereffects remain of paramount importance to improve kidney transplant outcomes.

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Section: Discussionmentioning

confidence: 99%

Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation

Famure

et al. 2015

Kidney International

179

143

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“…We found that HLA-DR mismatches in kidney transplant patients are significantly related to rejection treatment during the first year post-transplant and to high-dose maintenance immunosuppression ( Figure 1) (8). Others also have found HLA-DR mismatch to be associated with an increased risk of acute rejection (41)(42)(43)(44). Nikkel et al have reported that acute rejection confers an increased risk of bone fracture (37).…”

Section: Incidence Of Post-transplant Hip Fracture and Hla Mismatchesmentioning

confidence: 67%

Ceppellini Lecture 2012: Collateral damage from HLA mismatching in kidney transplantation

Opelz

Döhler

2013

Tissue Antigens

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Inclusion of human leukocyte antigen (HLA) matching in donor kidney allocation schemes has been based solely on its association with graft survival. Other long-term effects associated with HLA incompatibility are largely unexplored. Data from deceased donor kidney transplants reported to the Collaborative Transplant Study have been analyzed to assess the relation between HLA mismatching and clinical events to 3 years post-transplant, and an overview of these analyses is presented. A significant correlation was observed between the number of mismatches and the need for anti-rejection therapy during the first year post-transplant, which was maintained for HLA-DR and HLA-A + B mismatching separately and at years 2 and 3 post-transplant. The number of HLA-DR mismatches and the number of HLA-A + B mismatches as well as rejection treatment showed significant associations with the dose of maintenance steroids. The cumulative incidences of death with a functioning graft from infection or cardiovascular causes, but not from cancer, were also significantly associated with HLA mismatching. The number of HLA-DR mismatches showed a significant association with the incidence of non-Hodgkin lymphoma and hip fractures. These findings show that the adverse consequences of HLA mismatching on kidney transplants extend beyond an effect on graft survival, and include an increased risk of death with a functioning graft, non-Hodgkin lymphoma and hip fracture.

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“…Mismatched HLA‐DR grafts particularly elicit CD4 + T‐cell responses, which modulate immune responses that may trigger allograft rejection. Furthermore, clinical analyses show that HLA‐DR mismatches are related to an increased risk of acute rejection, to an intensified rejection treatment, and to high‐dose maintenance immunosuppression .…”

Section: Discussionmentioning

confidence: 99%

Pretransplant human leukocyte antigen antibodies detected by single-antigen bead assay are a risk factor for long-term kidney graft loss even in the absence of donor-specific antibodies

et al. 2016

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SUMMARYClinical relevance of ELISA-and single-antigen bead assay (SAB)-detected pretransplant HLA antibodies (SAB-HLA-Ab) for kidney graft survival was evaluated retrospectively in 197 patients transplanted between 2002 and 2009 at the University Clinic Frankfurt. Having adjusted for retransplantation and delayed graft function, a significantly increased risk for death-censored graft loss was found in patients with pretransplant SAB-HLA-Ab [HR: 4.46; 95% confidence interval (CI): 1.47-13.48; P = 0.008]. The risk for increased graft loss was also significant in patients with pretransplant SAB-HLA-Ab but without SAB-detected donor-specific Ab (SAB-DSA) (HR: 4.91; 95% CI of 1.43-16.991; P = 0.012). ELISA was not sufficient to identify pretransplant immunized patients with an increased risk for graft loss. In immunized patients, graft loss was predominantly present in patients who received transplants with a mismatch on the HLA-DR locus. In conclusion, even if our study is limited due to small sample size, the results show an increased risk for long-term graft loss in patients with pretransplant SAB-HLA, even in the absence of DSA. SAB-HLA-Ab-positive patients, being negative in ELISA or CDC assay, might profit from a well-HLA-DR-matched graft and intensified immunosuppression. Transplant International 2016; 29: 988-998

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Risk factors for acute rejection in renal transplant recipients experiencing delayed graft function

Cited by 12 publications

References 40 publications

Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation

Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation

Ceppellini Lecture 2012: Collateral damage from HLA mismatching in kidney transplantation

Pretransplant human leukocyte antigen antibodies detected by single-antigen bead assay are a risk factor for long-term kidney graft loss even in the absence of donor-specific antibodies

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