Survival of Highly Sensitized Patients on the Waiting List for Kidney Transplantation at Modena Transplant Center

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.04.010

Giacomo Mori , Jessica Plessi , Niccolò Morisi , Laura Tonelli , Laura Melara , Giuseppe Oliviero , Alice Parmigiani , Marco Ferrarini , Stefano Di Sandro , Gabriele Donati

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引用次数: 0

Abstract

Background

HLA sensitization plays a pivotal role in kidney transplantation. The presence of anti HLA antibodies strongly limits access to transplantation to subjects on the waiting list, particularly for highly sensitized patients. The aim of this study is to evaluate the waiting time of highly sensitized candidates, when compared with patients with a lower level of sensitization, and the respective survival rates on the waiting list.

Methods

We conducted a single center retrospective observational study stratified according to calculated panel reactive antibodies (cPRAs) in highly sensitized patients (cPRA ≥ 80%) and patients with a lower level of sensitization (NH; cPRA < 80%). A total of 911 patients on the waiting list were considered. Survival analysis was performed according to Kaplan Meier, and multivariate analysis was performed with Cox regression. Mortality data were collected only for 222 patients who were residents in the Province of Modena, Italy.

Results

Highly sensitized subjects have a significantly longer waiting time from enrollment to kidney transplantation when compared to patients with a lower level of sensitization, but in our highly sensitized patients the mortality rate resulted slightly lower because of the protective effect of a younger age at enrollment.

Conclusions

Highly sensitized patients wait longer to achieve kidney transplantation, but they do not show worse survival rates, likely because of a younger age at enrollment. These results highlight the importance of innovative strategies to allow access to transplantation to highly sensitive subjects to limit the personal and social cost of a prolonged stay on dialysis.

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摩德纳移植中心肾移植等候名单上高度敏感患者的生存率

背景：HLA致敏在肾移植中起着关键作用。抗HLA抗体的存在极大地限制了等待名单上的患者接受移植，特别是高度敏感的患者。本研究的目的是评估高致敏候选患者与低致敏患者相比的等待时间，以及等待名单上各自的存活率。方法：我们对高致敏患者（cPRA≥80%）和低致敏患者(NH；cPRA < 80%)。共有911名患者在等候名单上。生存分析采用Kaplan Meier法，多因素分析采用Cox回归法。仅收集了222名意大利摩德纳省居民的死亡率数据。结果：与致敏程度较低的患者相比，高度致敏的患者从入组到肾移植的等待时间明显更长，但在我们的高度致敏患者中，由于入组时年龄较年轻的保护作用，死亡率略低。结论：高度敏感的患者等待更长的时间才能实现肾移植，但他们的生存率并不差，可能是因为入组时年龄更小。这些结果强调了创新策略的重要性，允许对高度敏感的受试者进行移植，以限制长期透析的个人和社会成本。

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.