Eun Yee Hew1, Nicos Kessaris2,3,4, Jelena Stojanovic2, Helen Jones4, Martin Christian5, Anusha Edwards6, David V Milford7, Milos Ognjanovic8, Mohan Shenoy9, Richard J Baker10, Stephen D Marks11,12. 1. NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK. 2. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. 3. Department of Nephrology and Transplantation, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, UK. 4. Department of Paediatric Nephro-Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, UK. 5. Department of Pediatric Nephrology, Nottingham Children's Hospital, Nottingham, NG7 2UH, UK. 6. Renal Transplantation Unit, Southmead Hospital, Southmead Road, Bristol, BS110 5NB, UK. 7. Department of Paediatric Nephrology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. 8. Department of Paediatric Nephrology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK. 9. Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK. 10. Renal Unit, Lincoln Wing, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK. 11. NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK. stephen.marks@gosh.nhs.uk. 12. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. stephen.marks@gosh.nhs.uk.
Abstract
BACKGROUND: There is increasing evidence of good short-term and medium-term outcomes of ABO incompatible (ABOi) and HLA incompatible (HLAi) kidney transplantation with pre-transplant positive crossmatches in paediatric practice. However, there remain concerns regarding the higher risks of infective complications and antibody-mediated rejections. The aim of our study is to show longer-term follow-up on all ABOi and HLAi paediatric kidney transplant recipients (pKTR) in the UK. METHODS: Questionnaires specifying kidney transplant type, desensitisation requirement and kidney allograft function were sent to 13 paediatric nephrology centres that performed kidney transplantation in children and young people under 18 years of age who received an ABOi and/or HLAi transplant between 1 January 2006 and 31 December 2016. Patient and kidney allograft survival were compared between ABOi, HLAi and ABO/HLA compatible (ABOc/HLAc) groups. RESULTS: Among 711 living donor kidney transplants performed in the UK, 23 were ABOi and 6 were HLAi. Patient survival was 87%, 100% and 96% in ABOi, HLAi and ABOc/HLAc groups, respectively, at median follow-up of 6.8 (3.6-14.0) years post-transplant. Death-censored kidney allograft survival was 100% in all 3 groups at last follow-up. There were no cases of primary non-function in ABOi or HLAi groups, but 2% in the ABOc/HLAc group. There was one reported case of Epstein-Barr viral-induced post-transplant lymphoproliferative disorder. CONCLUSION: Longer term follow-up has shown that ABOi and HLAi kidney transplantation are feasible for pKTR where no compatible donors are available, and that minimising desensitisation should be achieved where possible. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: There is increasing evidence of good short-term and medium-term outcomes of ABO incompatible (ABOi) and HLA incompatible (HLAi) kidney transplantation with pre-transplant positive crossmatches in paediatric practice. However, there remain concerns regarding the higher risks of infective complications and antibody-mediated rejections. The aim of our study is to show longer-term follow-up on all ABOi and HLAi paediatric kidney transplant recipients (pKTR) in the UK. METHODS: Questionnaires specifying kidney transplant type, desensitisation requirement and kidney allograft function were sent to 13 paediatric nephrology centres that performed kidney transplantation in children and young people under 18 years of age who received an ABOi and/or HLAi transplant between 1 January 2006 and 31 December 2016. Patient and kidney allograft survival were compared between ABOi, HLAi and ABO/HLA compatible (ABOc/HLAc) groups. RESULTS: Among 711 living donor kidney transplants performed in the UK, 23 were ABOi and 6 were HLAi. Patient survival was 87%, 100% and 96% in ABOi, HLAi and ABOc/HLAc groups, respectively, at median follow-up of 6.8 (3.6-14.0) years post-transplant. Death-censored kidney allograft survival was 100% in all 3 groups at last follow-up. There were no cases of primary non-function in ABOi or HLAi groups, but 2% in the ABOc/HLAc group. There was one reported case of Epstein-Barr viral-induced post-transplant lymphoproliferative disorder. CONCLUSION: Longer term follow-up has shown that ABOi and HLAi kidney transplantation are feasible for pKTR where no compatible donors are available, and that minimising desensitisation should be achieved where possible. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Robert A Montgomery; Bonnie E Lonze; Karen E King; Edward S Kraus; Lauren M Kucirka; Jayme E Locke; Daniel S Warren; Christopher E Simpkins; Nabil N Dagher; Andrew L Singer; Andrea A Zachary; Dorry L Segev Journal: N Engl J Med Date: 2011-07-28 Impact factor: 91.245
Authors: K Tanabe; K Takahashi; K Sonda; T Tokumoto; N Ishikawa; T Kawai; S Fuchinoue; T Oshima; T Yagisawa; H Nakazawa; N Goya; S Koga; H Kawaguchi; K Ito; H Toma; T Agishi; K Ota Journal: Transplantation Date: 1998-01-27 Impact factor: 4.939
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Authors: Jelena Stojanovic; Anna Adamusiak; Nicos Kessaris; Pankaj Chandak; Zubir Ahmed; Neil J Sebire; Grainne Walsh; Helen E Jones; Stephen D Marks; Nizam Mamode Journal: Transplantation Date: 2017-06 Impact factor: 4.939