Article ; Online: Long-term Outcomes of Kidney Transplantation in Patients With High Levels of Preformed DSA: The Necker High-Risk Transplant Program.
2017 Volume 101, Issue 10, Page(s) 2440–2448
Abstract: Background: There is an increasing number of anti-HLA sensitized and highly sensitized renal transplant candidates on waiting lists, and the presence of donor-specific alloantibodies (DSAs) at the time of transplantation leads to acute and chronic ... ...
| Abstract | Background: There is an increasing number of anti-HLA sensitized and highly sensitized renal transplant candidates on waiting lists, and the presence of donor-specific alloantibodies (DSAs) at the time of transplantation leads to acute and chronic antibody-mediated rejection (AMR). Acceptable short-term outcomes have been described, notably because of desensitization protocols, but mid- and long-term data are still required. Methods: Our high immunologic risk program included 95 patients with high peak or day 0 DSA levels (mean fluorescence intensity [MFI] > 3000) with a complement-dependent cytotoxicity-negative crossmatch, who received a posttransplant desensitization protocol starting at day 0 with high-dose intravenous immunoglobulin, plasma exchanges, and eventually rituximab. Their characteristics were compared with a control group including 39 patients with a lower immunologic risk (MFI between 500 and 3000 at day 0) who received the same posttransplant desensitization. Results: The median MFI of the immunodominant class I or II DSA in the peak or day 0 serum was 9421 (interquartile range, 4959-12 610). An AMR occurred during the first posttransplant year in 31 patients (32.6%), and at one year, the rate of chronic AMR was 39.5%. The 1-, 3-, 5- and 7-year death-censored allograft survival rates were 98%, 91%, 86%, and 78%, respectively, with concomitant recipient survival rates of 97%, 93%, 85%, and 79%, respectively. Conclusions: These results suggest that DSA-sensitized patients with high MFI levels can receive transplantation across the HLA-barrier, with the use of an intensified posttransplant immunosuppressive therapy starting at day 0 combined with close clinical, immunologic, and histologic monitoring. |
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| MeSH term(s) | Adult ; Allografts ; Biomarkers ; Donor Selection ; Female ; Graft Rejection/immunology ; Graft Rejection/prevention & control ; Graft Survival ; HLA Antigens/immunology ; Histocompatibility ; Humans ; Immunosuppressive Agents/therapeutic use ; Isoantibodies/blood ; Kaplan-Meier Estimate ; Kidney Transplantation/adverse effects ; Kidney Transplantation/mortality ; Male ; Middle Aged ; Paris ; Program Evaluation ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome |
| Chemical Substances | Biomarkers ; HLA Antigens ; Immunosuppressive Agents ; Isoantibodies |
| Language | English |
| Publishing date | 2017-10 |
| Publishing country | United States |
| Document type | Journal Article ; Observational Study |
| ZDB-ID | 208424-7 |
| ISSN | 1534-6080 ; 0041-1337 |
| ISSN (online) | 1534-6080 |
| ISSN | 0041-1337 |
| DOI | 10.1097/TP.0000000000001650 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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