Trijntje J W Rennie, Richard K Battle, Angela A Abel, Sylvia McConnell, Robert McLaren, Paul J Phelan, Colin Geddes, Neal Padmanabhan, Marc J Clancy, Ann-Margaret Little, David M Turner
{"title":"HLA相容和HLA不相容肾移植结果的比较:一项国家队列研究。","authors":"Trijntje J W Rennie, Richard K Battle, Angela A Abel, Sylvia McConnell, Robert McLaren, Paul J Phelan, Colin Geddes, Neal Padmanabhan, Marc J Clancy, Ann-Margaret Little, David M Turner","doi":"10.1111/nep.14102","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Reports of HLA incompatible (HLAi) kidney transplant outcomes are inconclusive, especially in the context of lower level Donor Specific Antibodies (DSA).</p><p><strong>Methods: </strong>Multi-centre national cohort study of HLAi kidney transplant recipients matched in 1:2 ratio with HLA compatible (HLAc) kidney transplant recipients. HLAi defined as DSA identified by Luminex. Antibody mediated rejection (AMR) and transplant-survival were analysed using Kaplan-Meier plots. Propensity score (PS) matching was used to compare recipient and transplant survival between groups.</p><p><strong>Results: </strong>We included 61 HLAi and 122 HLAc recipients; mean age 46 years; 60% female. MFI<sub>T0</sub> : 3327 (IQR 1352-6458), 23 (38%) were Flow cytometry crossmatch positive (FC-XM<sub>POS</sub> ). DSA<sub>POS</sub> /FC-XM<sub>POS</sub> transplantation carried an increased risk of AMR at 1 year (52%) compared to DSA<sub>POS</sub> /FC-XM<sub>NEG</sub> (27%) and HLAc (0%). Unadjusted death censored graft loss at 3 years was 13% (HLAi) and 8% (HLAc). Three-year patient survival was 95% in HLAc, 84% in DSA<sub>POS</sub> /FC-XM<sub>NEG</sub> and 69% in DSA<sub>POS</sub> /FC-XM<sub>POS</sub> recipients; 58% of HLAi deaths were infection-related. HLA incompatibility was associated with a decreased 3-year survival in our PS-matched cohort.</p><p><strong>Conclusion: </strong>In kidney transplantation, DSA and positive FC-XM carries an increased risk of AMR. Despite inferior transplant and survival outcomes compared to HLAc transplantation, it remains a realistic option for highly sensitized patients facing prolonged waiting times and reduced survival on dialysis.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":" ","pages":"962-972"},"PeriodicalIF":1.9000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Comparison of kidney transplant outcomes in HLA compatible and incompatible transplantation: A national cohort study.\",\"authors\":\"Trijntje J W Rennie, Richard K Battle, Angela A Abel, Sylvia McConnell, Robert McLaren, Paul J Phelan, Colin Geddes, Neal Padmanabhan, Marc J Clancy, Ann-Margaret Little, David M Turner\",\"doi\":\"10.1111/nep.14102\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Reports of HLA incompatible (HLAi) kidney transplant outcomes are inconclusive, especially in the context of lower level Donor Specific Antibodies (DSA).</p><p><strong>Methods: </strong>Multi-centre national cohort study of HLAi kidney transplant recipients matched in 1:2 ratio with HLA compatible (HLAc) kidney transplant recipients. HLAi defined as DSA identified by Luminex. Antibody mediated rejection (AMR) and transplant-survival were analysed using Kaplan-Meier plots. Propensity score (PS) matching was used to compare recipient and transplant survival between groups.</p><p><strong>Results: </strong>We included 61 HLAi and 122 HLAc recipients; mean age 46 years; 60% female. MFI<sub>T0</sub> : 3327 (IQR 1352-6458), 23 (38%) were Flow cytometry crossmatch positive (FC-XM<sub>POS</sub> ). DSA<sub>POS</sub> /FC-XM<sub>POS</sub> transplantation carried an increased risk of AMR at 1 year (52%) compared to DSA<sub>POS</sub> /FC-XM<sub>NEG</sub> (27%) and HLAc (0%). Unadjusted death censored graft loss at 3 years was 13% (HLAi) and 8% (HLAc). Three-year patient survival was 95% in HLAc, 84% in DSA<sub>POS</sub> /FC-XM<sub>NEG</sub> and 69% in DSA<sub>POS</sub> /FC-XM<sub>POS</sub> recipients; 58% of HLAi deaths were infection-related. HLA incompatibility was associated with a decreased 3-year survival in our PS-matched cohort.</p><p><strong>Conclusion: </strong>In kidney transplantation, DSA and positive FC-XM carries an increased risk of AMR. Despite inferior transplant and survival outcomes compared to HLAc transplantation, it remains a realistic option for highly sensitized patients facing prolonged waiting times and reduced survival on dialysis.</p>\",\"PeriodicalId\":520716,\"journal\":{\"name\":\"Nephrology (Carlton, Vic.)\",\"volume\":\" \",\"pages\":\"962-972\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nephrology (Carlton, Vic.)\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/nep.14102\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/9/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nephrology (Carlton, Vic.)","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/nep.14102","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/9/21 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
Comparison of kidney transplant outcomes in HLA compatible and incompatible transplantation: A national cohort study.
Background: Reports of HLA incompatible (HLAi) kidney transplant outcomes are inconclusive, especially in the context of lower level Donor Specific Antibodies (DSA).
Methods: Multi-centre national cohort study of HLAi kidney transplant recipients matched in 1:2 ratio with HLA compatible (HLAc) kidney transplant recipients. HLAi defined as DSA identified by Luminex. Antibody mediated rejection (AMR) and transplant-survival were analysed using Kaplan-Meier plots. Propensity score (PS) matching was used to compare recipient and transplant survival between groups.
Results: We included 61 HLAi and 122 HLAc recipients; mean age 46 years; 60% female. MFIT0 : 3327 (IQR 1352-6458), 23 (38%) were Flow cytometry crossmatch positive (FC-XMPOS ). DSAPOS /FC-XMPOS transplantation carried an increased risk of AMR at 1 year (52%) compared to DSAPOS /FC-XMNEG (27%) and HLAc (0%). Unadjusted death censored graft loss at 3 years was 13% (HLAi) and 8% (HLAc). Three-year patient survival was 95% in HLAc, 84% in DSAPOS /FC-XMNEG and 69% in DSAPOS /FC-XMPOS recipients; 58% of HLAi deaths were infection-related. HLA incompatibility was associated with a decreased 3-year survival in our PS-matched cohort.
Conclusion: In kidney transplantation, DSA and positive FC-XM carries an increased risk of AMR. Despite inferior transplant and survival outcomes compared to HLAc transplantation, it remains a realistic option for highly sensitized patients facing prolonged waiting times and reduced survival on dialysis.
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