Graft Intolerance Syndrome Complicates Retransplantation

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-01 DOI:10.1016/j.transproceed.2024.11.027

Manuel Parra Collado , Paula Gandía Ureña , Eva Gavela Martínez , Julia Kanter Berga , Cristina Castro Alonso , Emma Calatayud Aristoy , Aina Quilis Pellicer , Sandra Beltrán Catalán , Belén Vizcaíno Castillo , Asunción Sancho Calabuig

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引用次数: 0

Abstract

Background

Patients with non-functioning renal grafts constitute approximately 4% of patients with incident dialysis. Complete withdrawal of immunosuppression has been associated with a higher risk of HLA sensitization and renal graft intolerance syndrome (GIS).

Methods

We conducted a retrospective observational study of 63 patients with renal graft failure (from January 2012 to December 2022). Immediate graft losses due to vascular thrombosis or technical complications were excluded. We analyzed demographic and clinical characteristics, as well as the evolution of GIS. A comparative study was performed with patients who did not develop GIS (non-GIS).

Results

Twenty-three patients (36.5%) developed GIS. The most common presentation was anemia (73.9%), followed by renal graft pain (65.2%). Seventeen patients (74%) required renal graft embolization. GIS was associated with a higher degree of sensitization. We did not find differences in prior HLA sensitization, causes of graft failure, history of acute rejection, or doses/levels of immunosuppression after graft failure, although rejections were more severe in the GIS group. Patients with GIS had a lower rate of retransplantation after graft failure (4.3% vs 25%, P = .02). Graft failure within the first 2 years after transplantation was the main predictive factor for GIS (hazard ratio = 2.740, 95% confidence interval = 1.06–7.06, P = .03).

Conclusions

GIS was more prevalent in patients who experienced graft failure within the first 2 years. Despite increased immunosuppression, a significant percentage required graft embolization. GIS was associated with an increase in HLA sensitization and a lower likelihood of retransplantation.

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移植物不耐受综合征并发再移植。

背景：无功能肾移植患者约占突发透析患者的4%。完全停止免疫抑制与HLA致敏和肾移植不耐受综合征（GIS）的高风险相关。方法：对63例移植肾衰竭患者（2012年1月至2022年12月）进行回顾性观察研究。由于血管血栓形成或技术并发症导致的移植物立即损失被排除在外。我们分析了人口统计学和临床特征，以及地理信息系统的发展。对未发生GIS（非GIS）的患者进行了比较研究。结果：23例（36.5%）发生GIS。最常见的表现是贫血（73.9%），其次是肾移植疼痛（65.2%）。17例（74%）患者需要肾移植栓塞。GIS与较高程度的敏感性相关。虽然GIS组的排斥反应更严重，但我们没有发现之前的HLA致敏性、移植物失败的原因、急性排斥史或移植物失败后免疫抑制的剂量/水平的差异。GIS患者移植失败后再移植率较低（4.3% vs 25%, P = 0.02）。移植后2年内移植物衰竭是GIS的主要预测因素（风险比= 2.740,95%可信区间= 1.06-7.06,P = 0.03）。结论：GIS在前2年内发生移植物衰竭的患者中更为普遍。尽管免疫抑制增强，但仍有很大比例的患者需要移植物栓塞。GIS与HLA敏化增加和再移植可能性降低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.