학술논문
Pre‐transplant donor‐specific HLA antibodies and risk for poor first‐year renal transplant outcomes: results from the Swiss Transplant Cohort Study.
Document Type
Article
Author
Wehmeier, Caroline; Amico, Patrizia; Sidler, Daniel; Wirthmüller, Urs; Hadaya, Karine; Ferrari‐Lacraz, Sylvie; Golshayan, Déla; Aubert, Vincent; Schnyder, Aurelia; Sunic, Kata; Schachtner, Thomas; Nilsson, Jakob; Schaub, Stefan; Axel, Andres; Aubert, John‐David; Banz, Vanessa; Sonja, Beckmann; Beldi, Guido; Berger, Christoph; Berishvili, Ekaterine
Source
Subject
*KIDNEY transplantation
*TREATMENT effectiveness
*TRANSPLANTATION of organs, tissues, etc.
*GRAFT rejection
*GRAFT survival
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Language
ISSN
0934-0874
Abstract
Summary: The aim of this study was to analyze first year renal outcomes in a nationwide prospective multicenter cohort comprising 2215 renal transplants, with a special emphasis on the presence of pre‐transplant donor‐specific HLA antibodies (DSA). All transplants had a complete virtual crossmatch and DSA were detected in 19% (411/2215). The investigated composite endpoint was a poor first‐year outcome defined as (i) allograft failure or (ii) death or (iii) poor allograft function (eGFR ≤25 ml/min/1.73 m2) at one year. Two hundred and twenty‐one (221/2215; 10%) transplants showed a poor first‐year outcome. Rejection (24/70; 34%) was the most common reason for graft failure. First‐year patient's death was rare (48/2215; 2%). There were no statistically significant differences between DSA‐positive and DSA‐negative transplants regarding composite and each individual endpoint, as well as reasons for graft failure and death. DSA‐positive transplants experienced more frequently rejection episodes, mainly antibody‐mediated rejection (both P < 0.0001). The combination of DSA and any first year rejection was associated with the overall poorest death‐censored allograft survival (P < 0.0001). In conclusion, presence of pre‐transplant DSA per se does not affect first year outcomes. However, DSA‐positive transplants experiencing first year rejection are a high‐risk population for poor allograft survival and may benefit from intense clinical surveillance. [ABSTRACT FROM AUTHOR]