Kwaku Marfo1, Maria Ajaimy, Adriana Colovai, Liise Kayler, Stuart Greenstein, Michelle Lubetzky, Anjali Gupta, Layla Kamal, Graciela de Boccardo, Peter Masiakos, Milan Kinkhabwala, Enver Akalin. 1. 1 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 2 Department of Pharmacy, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 3 Renal Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 4 Department of Transplant Immunology and Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 5 Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 6 Address correspondence to: Enver Akalin, M.D., Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467.
Abstract
BACKGROUND: Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. METHODS: Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. RESULTS: Patients had a mean number of 1.6 ± 0.8 DSAs with a mean fluorescence intensity value of 2,815 ± 2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129 ± 49 and 159 ± 52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA- groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA- group were similar. Two DSA+ (3%) and five DSA- (2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4 ± 0.6 mg/dL). CONCLUSION: Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSA- patients with pretransplantation immunologic risk assessment.
BACKGROUND:Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study. METHODS: Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment. RESULTS:Patients had a mean number of 1.6 ± 0.8 DSAs with a mean fluorescence intensity value of 2,815 ± 2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129 ± 49 and 159 ± 52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA- groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA- group were similar. Two DSA+ (3%) and five DSA- (2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4 ± 0.6 mg/dL). CONCLUSION: Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSA- patients with pretransplantation immunologic risk assessment.
Authors: Dinesh Kannabhiran; John Lee; Joseph E Schwartz; Rex Friedlander; Meredith Aull; Thangamani Muthukumar; Sean Campbell; David Epstein; Surya V Seshan; Sandip Kapur; Vijay K Sharma; Manikkam Suthanthiran; Darshana Dadhania Journal: Transplantation Date: 2015-06 Impact factor: 4.939
Authors: Audrey Uffing; Luis G Hidalgo; Ciaran McMullan; Jacqueline Perry; Edgar L Milford; Naoka Murakami; Melissa Y Yeung; Indira Guleria; Isabelle G Wood; Enver Akalin; Jamil Azzi; Anil K Chandraker; Leonardo V Riella Journal: Transplant Direct Date: 2019-04-15
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