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Kidney Transplant With Low Levels of DSA or Low Positive B-Flow Crossmatch: An Underappreciated Option for Highly Sensitized Transplant Candidates

Overview
Journal Transplantation
Specialty General Surgery
Date 2016 Dec 24
PMID 28009780
Citations 24
Authors
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Abstract

Background: Avoiding donor-specific antibody (DSA) is difficult for sensitized patients. Improved understanding of the risk of low level DSA is needed.

Methods: We retrospectively compared the outcomes of 954 patients transplanted with varied levels of baseline DSA detected by single antigen beads and B flow cytometric crossmatch (XM). Patients were grouped as follows: -DSA/-XM, +DSA/-XM, +DSA/low +XM, +DSA/high +XM, and -DSA/+XM and followed up for a mean of 4.1 ± 1.9 years (similar among groups, P = 0.49).

Results: Death-censored allograft survival was similar in all groups except the +DSA/high +XM group, which was lower at 79.1% versus 96.2% in the -DSA/-XM group (P < 0.01). The incidence of chronic antibody-mediated rejection (CAMR) based on surveillance biopsy was higher with increasing DSA (8.2% -DSA/-XM, 17.0% +DSA/-XM, 30.6% +DSA/low +XM, and 51.2% +DSA/high +XM, P < 0.01), but similar in groups without baseline DSA (8.1% -DSA/-XM vs 15.4% -DSA/+XM, P = 0.19). Having a calculated panel-reactive antibody (cPRA) of 80% or greater was independently associated with CAMR (hazard ratio, 5.2; P = 0.03) even when DSA was undetected at baseline. By 2 years posttransplant, the incidence of CAMR was 19.4% in patients with cPRA of 80% or greater and undetected DSA and negative XM at baseline.

Conclusions: Kidney transplantation with low-level DSA with or without a low positive XM is a reasonable option for highly sensitized patients and may be advantageous compared with waiting for a negative XM deceased donor. The risk for CAMR is low in patients with no DSA even if the XM is positive. Patients with cPRA of 80% or greater are at risk for CAMR even if no DSA is detected.

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Selective Elimination and Rationalization of Cell-based Assays in Deceased Donor Kidney Transplant Crossmatching.

Khalili M, Famure O, Minkovich M, Tinckam K, Kim S Transplant Direct. 2024; 10(4):e1603.

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Diagnostic performance of GcfDNA in kidney allograft rejection: a meta-analysis.

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References
1.
Hariharan S, Adams M, Brennan D, Davis C, First M, Johnson C . Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR). Transplantation. 1999; 68(5):635-41. DOI: 10.1097/00007890-199909150-00007. View

2.
Vo A, Lukovsky M, Toyoda M, Wang J, Reinsmoen N, Lai C . Rituximab and intravenous immune globulin for desensitization during renal transplantation. N Engl J Med. 2008; 359(3):242-51. DOI: 10.1056/NEJMoa0707894. View

3.
Haas M, Sis B, Racusen L, Solez K, Glotz D, Colvin R . Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant. 2014; 14(2):272-83. DOI: 10.1111/ajt.12590. View

4.
Loupy A, Lefaucheur C, Vernerey D, Prugger C, Duong van Huyen J, Mooney N . Complement-binding anti-HLA antibodies and kidney-allograft survival. N Engl J Med. 2013; 369(13):1215-26. DOI: 10.1056/NEJMoa1302506. View

5.
Tambur A, Herrera N, Haarberg K, Cusick M, Gordon R, Leventhal J . Assessing Antibody Strength: Comparison of MFI, C1q, and Titer Information. Am J Transplant. 2015; 15(9):2421-30. DOI: 10.1111/ajt.13295. View