The PROCARE consortium: Toward an improved allocation strategy for kidney allografts

Otten, H.G.; Joosten, Irma; Allebes, Wil A.; Meer, Arnold van der; Hilbrands, Luuk B.; Baas, Marije C.; Spierings, Eric; Hack, C. E.; Reekum, Franka van; Zuilen, Arjan D. van; Verhaar, Marianne C.; Bots, Michiel L.; Seelen, Marc A.; Sanders, Jan-Stephan; Hepkema, Bouke; Lambeck, Annechien J. A.; Bungener, Laura; Roozendaal, Caroline; Tilanus, Marcel G.J.; Vanderlocht, Joris; Voorter, C. E. M.; Wieten, Lotte; Duijnhoven, E. van; Gelens, M.; Christiaans, M. H. L.; Ittersum, Frans van; Nurmohamed, Azam; Lardy, Neubury M.; Swelsen, Wendy; Pant, Karlijn A.M.I. van Donselaar-van der; Weerd, Neelke C. van der; Berge, Ineke J. M. ten; Bemelman, F. J.; Hoitsma, A.J.; Fijter, Johan W. de; Betjes, Michiel G. H.; Roelen, Dave L.; Claas, Frans H.J.

doi:10.1016/j.trim.2014.09.008

Cited by 20 publications

(22 citation statements)

References 33 publications

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“…9 All transplants required a negative CDC crossmatch using both peak and current sera. 9 All transplants required a negative CDC crossmatch using both peak and current sera.…”

Section: Patientsmentioning

confidence: 99%

“…We performed a post hoc analysis on the PROCARE cohort, which includes all renal transplants performed in the Netherlands between January 1995 and December 2005 with available clinical follow-up. 9 All transplants required a negative CDC crossmatch using both peak and current sera. A detailed description of the cohort has been published previously.…”

Section: Patientsmentioning

confidence: 99%

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Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients

Heidt

Haasnoot

Witvliet

et al. 2019

American Journal of Transplantation

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Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long‐term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995‐2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6‐month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA‐B plus 1 HLA‐DR, or 2 HLA‐DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low‐risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals.

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“…9 All transplants required a negative CDC crossmatch using both peak and current sera. 9 All transplants required a negative CDC crossmatch using both peak and current sera.…”

Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients

Heidt

Haasnoot

Witvliet

et al. 2019

American Journal of Transplantation

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“…Within the Dutch National Profiling Consortium of Antibody Repertoire and Effector functions (PROCARE), pretransplant DSAs were measured retrospectively in all recipients of a kidney transplant in the period 1995-2005 in the Netherlands [14,15]. is offers a unique data set as clinical decision-making, and immune suppressive medications were not based on knowledge about pretransplant DSA status.…”

Section: Introductionmentioning

confidence: 99%

Pretransplant Donor-Specific Anti-HLA Antibodies and the Risk for Rejection-Related Graft Failure of Kidney Allografts

Betjes

Sablik

Otten

et al. 2020

Journal of Transplantation

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Background. The presence of donor-specific antibodies (DSAs) against HLA before kidney transplantation has been variably associated with decreased long-term graft survival. Data on the relation of pretransplant DSA with rejection and cause of graft failure in recipients of donor kidneys are scarce. Methods. Patients transplanted between 1995 and 2005 were included and followed until 2016. Donor-specific antibodies before transplantation were determined retrospectively. For cause, renal transplant biopsies were reviewed. Results. Pretransplant DSAs were found in 160 cases on a total of 734 transplantations (21.8%). In 80.5% of graft failures, a diagnostic renal biopsy was performed. The presence of pretransplant DSA (DSApos) increased the risk of graft failure within the first 3 months after transplantation (5.2% vs. 9.4%) because of rejection with intragraft thrombosis (p<0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos, p=0.01) with significant decreased graft survival at 10 years (79% DSAneg vs. 69% DSApos, p=0.02). This could largely contribute to an increased graft loss because of antibody-mediated rejection in the DSApos group. The incidence and graft loss because of T cell-mediated rejection was not affected by the presence of pretransplant DSA. Conclusions. Pretransplant DSAs are a risk factor for early graft loss and increase the incidence for humoral rejection and graft loss but do not affect the risk for T cell-mediated rejection.

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“…As part of Dutch national Profiling Consortium of Antibody Repertoire and Effector (PROCARE) functions, all kidney transplants performed in The Netherlands between 1995 and 2006 were evaluated retrospectively 24. This cohort was selected for several reasons: allocation or choice of immunosuppressive therapy was not influenced by the results of SAB assay–defined DSAs, patients had at least 10 years of follow‐up and relatively modern immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Kamburova

Wisse

Joosten

et al. 2018

American Journal of Transplantation

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The presence of donor‐specific anti‐HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long‐term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement‐dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10‐year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10‐year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10‐year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.

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The PROCARE consortium: Toward an improved allocation strategy for kidney allografts

Cited by 20 publications

References 33 publications

Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients

Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients

Pretransplant Donor-Specific Anti-HLA Antibodies and the Risk for Rejection-Related Graft Failure of Kidney Allografts

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

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