Five‐Year Outcomes in Living Donor Kidney Transplants With a Positive Crossmatch |
| |
Authors: | A. Bentall L. D. Cornell J. M. Gloor W. D. Park M. J. Gandhi J. L. Winters M. F. Chedid P. G. Dean M. D. Stegall |
| |
Affiliation: | 1. Division of Transplantation Surgery, von Liebig Transplant Center, Mayo Clinic, , Rochester, MN;2. Renal Institute of Birmingham, Queen Elizabeth Hospital, , Birmingham, UK;3. Division of Anatomic Pathology, von Liebig Transplant Center, Mayo Clinic, , Rochester, MN;4. Division of Nephrology and Hypertension, von Liebig Transplant Center, Mayo Clinic, , Rochester, MN;5. Division of Transfusion Medicine, von Liebig Transplant Center, Mayo Clinic, , Rochester, MN |
| |
Abstract: | Renal transplant candidates with high levels of donor‐specific anti‐HLA antibodies have low transplantation rates and high mortality rates on dialysis. Using desensitization protocols, good short‐term outcomes are possible in “positive crossmatch kidney transplants (+XMKTx)”, but long‐term outcome data are lacking. The aim of the current study was to determine actual 5‐year graft outcomes of +XMKTx. We compared graft survival and the functional and histologic status of 102 +XMKTx to 204 ?XMKTx matched for age and sex. Actual 5‐year death‐censored graft survival was lower in the +XMKTx group (70.7% vs. 88.0%, p < 0.01) and chronic injury (glomerulopathy) was present in 54.5% of surviving grafts. Graft survival was higher in recipients with antibody against donor class I only compared with antibody against class II (either alone or in combination with class I) (85.3% vs. 62.6%, p = 0.05) and was similar to ?XMKTx (85.3 vs. 88.0%, p = 0.64). Renal function and proteinuria ranged across a wide spectrum in all groups reflecting the different histological findings at 5 years. We conclude that when compared to ?XMKTx, +XMKTx have inferior outcomes at 5 years, however, almost half of the surviving grafts do not have glomerulopathy and avoiding antibodies against donor class II may improve outcomes. |
| |
Keywords: | Antibody‐mediated rejection donor‐specific antibodies HLA‐sensitized patients Long‐term outcomes positive crossmatch kidney transplant |
|
|