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

Carrie A Schinstock

Manish Gandhi

Wisit Cheungpasitporn

Donald Mitema

Mikel Prieto

Patrick Dean

Lynn Cornell

Fernando Cosio

Mark Stegall

Affiliations

Soon will be listed here.

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.

Citing Articles

Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story.

Shamseddin M, Paraskevas S, Mainra R, Maru K, Piggott B, Jagusic D Can J Kidney Health Dis. 2024; 11:20543581241306811.

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Translation of therapeutic strategies to modulate B cell reponses from non-human primate models to human kidney transplantation.

Knechtle S, Kwun J, Song S, Jackson A, Williams K, Sanoff S Front Transplant. 2024; 2:1176796.

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Challenges and opportunities for designing clinical trials for antibody mediated rejection.

Balakrishnan S, Alexander M, Schinstock C Front Transplant. 2024; 3:1389005.

PMID: 38993760 PMC: 11235363. DOI: 10.3389/frtra.2024.1389005.

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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