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• W2332620384 abstract "Introduction: Transplantation across immunological barriers, either ABO- or HLA-incompatibility, is a successful strategy to provide access to transplantation for patients hitherto deemed immunologically high-risk. However the safety and efficacy of crossing both immunological barriers simultaneously is scarcely reported. In this analysis we compared outcomes between renal transplant recipients transplanted across simultaneous ABO- and HLA-incompatible barriers (n=28) to recipients with ABO-incompatibility (n=68) or HLA-incompatibility (n=221) alone. Methods: We analysed adult incompatible kidney transplant recipients from a prospectively kept database. A total of 317 antibody-incompatible kidney transplant patients were transplanted from 1998 to 2010. 28 patients were transplanted against both immunological barriers and formed the patient cohort for this analysis. Protocol biopsies were performed for all patients on months 1, 3, 6 and 12 post-transplantation and ‘per cause’. Outcome data (including patient/graft survival, rejection and graft function) was available for all patients up to a median of 1088 days post-transplantation (range 0 to 4232 days). Results: From the 28 patients 62% were female (14/16 had previous pregnancies) and 57% had previously received a transplant (of whom just under half had received two or more transplants). Median age at transplantation was 45 (range 22 to 74). Total years of renal replacement therapy pre-transplant (dialysis/transplant) were a median of 10 years (range 0-28 years). Prior to any desensitisation, baseline donor-specific antibody strength was; CDC+ (8%), flow+ (61%), Luminex+ (31%). Concomitant baseline AHG isohaemoagglutinin titre was; 256 (21%), 128 (11%), 64 (25%), 32 (18%), 16 (14%) and 8 or under (11%). Early (< 3 months) biopsy proven cell-mediated, antibody-mediated or mixed-pattern rejection was observed in 7%, 29% and 18% of patients respectively. Late (>3 months) biopsy proven cell-mediated, antibody-mediated or mixed-pattern was observed in 18%, 18% and 0% of patients respectively. On one-year biopsy data 80% had C4d deposition (20% in absence of any evidence of glomerulitis or capillaritis), 45% has transplant glomerulopathy and 65% had peritubular capillaritis (15% isolated with no C4d deposition). Patient and graft survival (death-censored) at one-year was 96%% and 93% respectively, with creatinine in surviving kidneys a median of 1.0 mg/dl (range 0.8-4.4 mg.dl). After median follow up of 1088 days post-transplant, patient and death-censored graft survival was 93% and 82% respectively, with median creatinine in surviving kidneys 1.2 mg/dl. Contemporaneous HLA-incompatible patient and death-censored graft survival was 88% and 87% respectively, whilst in ABO-incompatible patient and death-censored graft survival was 85% and 79% respectively with comparable median follow up to simultaneous ABO/HLA-incompatible patients. Conclusion: This analysis demonstrates short-to-medium term safety and efficacy of transplanting patients across simultaneous ABO- and HLA-incompatible barriers, when compared to the outcomes of kidney transplantation across either immunological barrier alone." @default.
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• W2332620384 date "2012-11-01" @default.
• W2332620384 modified "2023-09-25" @default.
• W2332620384 title "Kidney Transplantation Across Simultaneous ABO/HLA-Incompatible Immunological Barriers Is Similar to Either ABO- or HLA-Incompatible Transplantation for Safety and Efficacy" @default.
• W2332620384 doi "https://doi.org/10.1097/00007890-201211271-00331" @default.
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