IngentaConnect Positive Cross-Match Living Donor Kidney Transplantation: Longer-...

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: Blackwell Publishing

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: 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

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