Positive Cross-Match Living Donor Kidney Transplantation: Longer-Term Outcomes

Authors: Haririan, A.; Nogueira, J.¹; Kukuruga, D.²; Schweitzer, E.³; Hess, J.⁴; Gurk-Turner, C.⁵; Jacobs, S.²; Drachenberg, C.³; Bartlett, S.²; Cooper, M.²

Source: American Journal of Transplantation, Volume 9, Number 3, March 2009 , pp. 536-542(7)

Publisher: Wiley-Blackwell

Buy & download fulltext article:

You have access to the full text article on a website external to ingentaconnect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library

Abstract:

The long-term graft outcomes after positive cross-match (PXM) living donor kidney transplantation (LDKT) are unknown and the descriptive published data present short-medium term results. We conducted a retrospective cohort study of LDKT with PXM by flow cytometry performed at our center during February 1999 to October 2006, compared to a control group, matched 1:1 for age, sex, race, retransplantation and transplant year. The PXM group was treated with a course of plasmapheresis/low-dose intravenous immunoglobulin (IVIg) preoperatively, and OKT3 or thymoglobulin induction.

Both groups (n = 41 each) were comparable except for duration of end-stage renal disease (ESRD), induction, HLA mismatch and panel-reactive antibody (PRA). During the period of up to 9 years, 14 PXM and 7 controls lost their grafts (p < 0.04). Graft survival rates at 1 and 5 years were 89.9% and 69.4% for PXM group and 97.6% and 80.6% for the controls, respectively. PXM was associated with higher risk of graft loss (HR 2.6, p = 0.04; 95%CI 1.03-6.4) (t_1/2= 6.8 years), but not with patient survival (HR 1.96, p = 0.29; 95%CI 0.6-7.0) or 1-year serum creatinine (β= 0.06, p = 0.59 for ln (SCr); 95% CI −0.16 to 0.28).

These results suggest that despite the favorable short-term results of PXM LDKT after PP/IVIg conditioning, medium-long-term outcomes are notably worse than expected, perhaps comparable to non-ECD deceased donor kidney transplantation (KT).

Keywords: Desensitzation; flow cytometry cross-match; intravenous immunoglobulin; kidney transplantation; plasma exchange; positive cross-match

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1600-6143.2008.02524.x

Affiliations: 1: Department of Medicine 2: Immunogenetics Laboratory 3: Department of Surgery 4: Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 5: Pharmacy, University of Maryland Medical Center, Baltimore, MD

Publication date: 2009-03-01

Positive Cross-Match Living Donor Kidney Transplantation: Longer-Term Outcomes

Buy & download fulltext article:

Tools

Key

Text size:

Useful pages