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Noguchi H, Miyamoto K, Matsukuma Y, Ueki K, Tsuchimoto A, Nakano T, Kaba A, Sato Y, Kubo S, Kaku K, Okabe Y, Nakamura M. A Single-Center Retrospective Study of Re-Transplantation After Allograft Failure in Kidney Transplant Recipients. Transplant Proc 2024; 56:488-493. [PMID: 38326204 DOI: 10.1016/j.transproceed.2024.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND This study aimed to examine the outcomes of kidney retransplantation in patients with allograft failure at Kyushu University. METHODS We reviewed data from 1043 consecutive patients (including 1001 in a first kidney transplantation [KT] group and 42 in a second KT group) who had undergone KT alone at our institution between January 2008 and September 2022. We also studied immunologic risks and outcomes of patients who had undergone preoperative testing for KT at Kyushu University during the same period. RESULTS No patient received more than 2 transplants. Donor-specific anti-HLA antibody (DSA) had been detected in a greater percentage of patients in the second KT group than in the first (31% vs 11%, respectively; P < .001). There were no significant differences in 5-year death-censored/overall graft survival rates, rates of surgical complications, or incidence of delayed graft function between the groups. During the study period, significantly more candidates for second than first KT were rejected for this procedure because of their high immunologic risk (20% vs 2%, P < 001). Seven of the 42 patients in the second KT group required the removal of the primary graft during the second transplantation. CONCLUSION There is a higher percentage of patients whose DSA has been detected among patients undergoing retransplantation after allograft failure than among those receiving first KTs, which often leads to remaining on the waiting list in the former group. However, if the immunologic risk is within acceptable limits, the graft survival for retransplantation is not inferior to that of a first KT.
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Affiliation(s)
- Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kyoko Miyamoto
- Center for Cellular and Molecular Medicine, Kyushu University, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Ueki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiro Tsuchimoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akari Kaba
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinsuke Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival. J Transplant 2022; 2022:3397751. [PMID: 35782455 PMCID: PMC9242806 DOI: 10.1155/2022/3397751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background There is an increasing demand for kidney retransplantation. Most studies report inferior outcomes compared to primary transplantation, consequently feeding an ethical dilemma in the context of chronic organ shortage. Objective To assess variables influencing long-term graft survival after kidney retransplantation. Material and Methods. All patients transplanted at our center between 2000 and 2016 were analyzed retrospectively. Survival was estimated with the Kaplan–Meier method, and risk factors were identified using multiple Cox regression. Results We performed 1,376 primary kidney transplantations and 222 retransplantations. The rate of retransplantation was 67.8% after the first graft loss, with a comparable 10-year graft survival compared to primary transplantation (67% vs. 64%, p=0.104) but an inferior graft survival thereafter (log-rank p=0.026). Independent risk factors for graft survival in retransplantation were age ≥ 50 years, time on dialysis ≥1 year, previous graft survival <2 years, ≥1 mild comorbidity in the Charlson–Deyo index, active smoking, and life-threatening complications (Clavien–Dindo grade IV) at first transplantation. Conclusion Graft survival is comparable for first and second kidney transplantation within the first 10 years. Risk factors for poor outcomes after retransplantation are previous graft survival, dialysis time after graft failure, recipient age, comorbidities, and smoking. Patients with transplant failure should have access to retransplantation as early as possible.
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Williams N, Korneffel K, Koizumi N, Ortiz J. African American polycystic kidney patients receive higher risk kidneys, but do not face increased risk for graft failure or post-transplant mortality. Am J Surg 2020; 221:1093-1103. [PMID: 33028497 DOI: 10.1016/j.amjsurg.2020.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
African Americans (AA) are disproportionately affected by end-stage renal disease (ESRD) and have worse outcomes following renal transplantation. Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic condition leading to ESRD necessitating transplant. We explored this population with respect to race by conducting a retrospective analysis of the UNOS database between 2005 and 2019. Our study included 10,842 (AA n = 1661; non-AA n = 9181) transplant recipients whose primary diagnosis was ADPKD. We further stratified the AA ADPKD population with respect to blood groups (AA blood type B n = 295 vs AA non-B blood type n = 1366), and also compared this cohort to AAs with a diagnosis of DM (n = 16,706) to identify unique trends in the ADPKD population. We analyzed recipient and donor characteristics, generated survival curves, and conducted multivariate analyses. African American ADPKD patients waited longer for transplants (924 days vs 747 days P < .001), and were more likely to be on dialysis (76% vs 62%; p < .001). This same group was also more likely to have AA donors (21% vs 9%; p < .001) and marginally higher KDPI kidneys (0.48 vs 0.45; p < .001). AA race was a risk factor for delayed graft function (DGF), increasing the chance of DGF by 45% (OR 1.45 95% CI 1.26-1.67; p < .001). AA race was not associated with graft failure (HR 1.10 95% CI 0.95-1.28; p = .21) or patient mortality (HR 0.84 95% CI 0.69-1.03; p = .09). Racial disparities exist in the ADPKD population. They should be continually studied and addressed to improve transplant equity.
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Affiliation(s)
- Nathan Williams
- College of Medicine and Life Science, University of Toledo, Toledo, OH, USA.
| | - Katie Korneffel
- College of Medicine and Life Science, University of Toledo, Toledo, OH, USA
| | | | - Jorge Ortiz
- Department of Surgery, Albany Medical College, Albany, NY, USA
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Ucar ZA, Sinangil A, Koc Y, Barlas S, Abouzahir S, Ecder ST, Akin EB. Clinical Prognosis of Renal Retransplant Patients: A Single-Center Experience. Transplant Proc 2019; 51:2274-2278. [PMID: 31474292 DOI: 10.1016/j.transproceed.2019.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Retransplantation is a treatment option in patients with end-stage renal failure due to graft loss. Outcomes of these patients due to high immunologic risk remain unclear. The aim of this study was to evaluate outcomes of renal retransplantation patients retrospectively. METHODS Renal retransplant patients in our unit were evaluated retrospectively between 2010 and 2018. Patients' demographic characteristics, primary diseases, the causes of prior graft loss, immunologic status, desensitization protocols, the induction and maintenance treatments, the complications during the follow-up period, numbers of acute rejections, and the clinical prognosis were all detected from the patients' files. RESULTS We retrospectively evaluated 17 patients who underwent a second or third renal allograft. Of these, 16 received a second and the remaining 1 patient received a third renal allograft. Immunologically, all of the 17 patients had negative flow cytometry crossmatch, 1 patient had a positive complement-dependent cytotoxicity crossmatch (Auto 12%), 16 patients had positive panel reactive antibody, the median HLA-mismatch was 3.5, and the score of donor-specific antibody relative intensity score (RIS) was 6.4 ± 6.3. Ten pretransplant patients had desensitization treatment. While scores for HLA-MM and HLA-RIS in the patients who had a desensitization therapy were determined higher, no statistical difference was observed (respectively, P = .28 and .55). No acute rejection episode developed. BK virus DNA viremia was detected in 4 patients during the posttransplant 6th month. We observed no patient death or no graft loss during the follow-up period. CONCLUSION Although the retransplant patients who had a graft loss previously have high immunologic risks, retransplantation is reliable in these patients, but they should be followed up carefully in terms of BKV nephropathy.
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Affiliation(s)
- Zuhal Atan Ucar
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey.
| | - Ayse Sinangil
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Yener Koc
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Soykan Barlas
- Unit of Renal Transplantation, Department of General Surgery, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Sana Abouzahir
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey; Department of Nephrology, Cheikh Anta Diop University, Dakar, Senegal
| | - Suleyman Tevfik Ecder
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Emin Baris Akin
- Unit of Renal Transplantation, Department of General Surgery, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
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Santos AH, Casey MJ, Womer KL. Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States. J Transplant 2017; 2017:8132672. [PMID: 29312783 PMCID: PMC5632904 DOI: 10.1155/2017/8132672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/24/2017] [Indexed: 01/16/2023] Open
Abstract
We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0.35-0.91 and HR = 0.54, 95% CI = 0.27-1.08, resp.), while AR risk was lower with alemtuzumab in retransplant recipients with >3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44-0.93 and HR = 0.81, 95% CI = 0.63-1.06, resp.); (2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54, 95% CI = 0.34-0.86 and HR = 0.73, 95% CI = 0.51-1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% CI = 0.43-0.98 and HR = 0.82, 95% CI = 0.60-1.12, resp.). Therefore, specific risk factor-induction regimen combinations may predict outcomes and this information may help in individualizing induction in retransplant recipients.
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Affiliation(s)
- Alfonso H. Santos
- Department of Medicine, Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, USA
| | - Michael J. Casey
- Department of Medicine, Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, USA
| | - Karl L. Womer
- Department of Medicine, Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, USA
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Increase of allosensitization after a kidney graft failure: Predictors and effect on retransplantation outcomes. Nefrologia 2017; 37:397-405. [PMID: 28576438 DOI: 10.1016/j.nefro.2016.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/14/2016] [Accepted: 11/17/2016] [Indexed: 01/16/2023] Open
Abstract
Patients who are candidates for a second kidney transplant (SKT) frequently have a higher level of panel reactive antibodies (PRA). We assessed the allosensitisation change after a first graft failure (GF), its predictors and impact on retransplantat outcomes. We retrospectively selected 140 adult patients who received a SKT. Recipient and donor characteristics were analyzed. We defined the delta PRA (dPRA) as the difference between peak PRA before the SKT and first one (cohort median value=+10%). Logistic regression analysis was used to determine risk factors for dPRA≥10% and acute rejection (AR) in the SKT. Univariable and multivariable Cox analysis was applied to assess independent predictors of second GF. Risk factors for dPRA≥10% at SKT were AR (OR=2.57; P=0.022), first graft survival <1 year (OR=2.47; P=0.030) and ABDR HLA mismatch (OR=1.38 per each mismatch; P=0.038). AR in the SKT was associated with dPRA≥10% (OR=2.79; P=0.047). Induction with a lymphocyte-depleting agent had a protective effect (OR=0.23; P=0.010). SKT survival was lower (P=0.008) in patients with a dPRA≥10% (75.6%, 60.5% in dPRA≥10%; 88.6%, 88.6% in dPRA<10% patients at 5 and 10 years, post-transplant respectively). Multivariable Cox regression showed that dPRA≥10% (HR=2.38, P=0.042), delayed graft function (HR=2.82, P=0.006) and AR (HR=3.30, P=0.001) in the SKT were independent predictors of retransplant failure. This study shows that an increased allosensitisation at retransplant was associated with the degree of HLA mismatch and led to poorer outcomes. De-emphasis of HLA matching in current allocation policies may be undesirable, particularly in patients with a higher chance of needing a SKT.
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Shu X, Schaubel DE. Semiparametric methods to contrast gap time survival functions: Application to repeat kidney transplantation. Biometrics 2015; 72:525-34. [PMID: 26501480 DOI: 10.1111/biom.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 08/01/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Abstract
Times between successive events (i.e., gap times) are of great importance in survival analysis. Although many methods exist for estimating covariate effects on gap times, very few existing methods allow for comparisons between gap times themselves. Motivated by the comparison of primary and repeat transplantation, our interest is specifically in contrasting the gap time survival functions and their integration (restricted mean gap time). Two major challenges in gap time analysis are non-identifiability of the marginal distributions and the existence of dependent censoring (for all but the first gap time). We use Cox regression to estimate the (conditional) survival distributions of each gap time (given the previous gap times). Combining fitted survival functions based on those models, along with multiple imputation applied to censored gap times, we then contrast the first and second gap times with respect to average survival and restricted mean lifetime. Large-sample properties are derived, with simulation studies carried out to evaluate finite-sample performance. We apply the proposed methods to kidney transplant data obtained from a national organ transplant registry. Mean 10-year graft survival of the primary transplant is significantly greater than that of the repeat transplant, by 3.9 months (p=0.023), a result that may lack clinical importance.
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Affiliation(s)
- Xu Shu
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, 48109-2029, U.S.A
| | - Douglas E Schaubel
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, 48109-2029, U.S.A
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8
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Abstract
BACKGROUND The waiting time for deceased donor renal transplantation in the United States continues to grow. Retransplant candidates make up a small but growing percentage of the overall transplant waiting list and raise questions about the stewardship of scarce resources. The utility of renal transplantation among individuals with two prior renal transplants is not described in the literature, and we thus sought to determine the survival benefit associated with a third kidney transplant (3KT). METHODS Multivariable Cox regression models were created to determine characteristics associated with 3KT outcomes and the survival benefit of 3KT among recipients wait listed and transplanted within the United States between 1995 and 2009. RESULTS A total of 4,334 patients were waitlisted for a 3KT and 2,492 patients received a 3KT. In a multivariate analysis, 3KT demonstrated an overall patient survival benefit compared to the waitlist (hazards ratio, 0.379; 95% confidence interval, 0.302-0.475; P<0.001) for those awaiting their first, second, or third kidney transplants, although an inferior graft outcome compared to first kidney transplants. The time to survival benefit did not accrue until 8 months after transplantation. In addition, we found that the duration of second graft survival was predictive of third graft survival, such that second graft survival beyond 5 years is associated with superior 3KT graft survival. Second graft loss in 30 days or less was not associated with inferior 3KT graft survival. CONCLUSION A 3KT achieves a survival benefit over remaining on the waitlist, although is associated with inferior graft outcomes compared to first kidney transplants. Graft survival of the second transplant beyond 5 years is associated with superior 3KT graft survival.
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Heaphy ELG, Poggio ED, Flechner SM, Goldfarb DA, Askar M, Fatica R, Srinivas TR, Schold JD. Risk factors for retransplant kidney recipients: relisting and outcomes from patients' primary transplant. Am J Transplant 2014; 14:1356-67. [PMID: 24731101 DOI: 10.1111/ajt.12690] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/14/2014] [Accepted: 02/02/2014] [Indexed: 01/25/2023]
Abstract
As of November 2013, 14.5% of the waitlist for a donor kidney comprised patients awaiting a retransplant. We performed a retrospective cohort study of 11,698 adult solitary kidney recipients using national Scientific Registry of Transplant Recipients data transplanted between 2002 and 2011. The aim was to investigate whether outcomes from patients' initial transplants are significant risk factors for patients' repeat transplants or for likelihood of relisting after a failed primary transplant. Retransplant recipients were more likely to be treated for acute rejection [adjusted odds ratio (AOR), 95% confidence interval (CI) = 1.26 (1.07-1.48), p = 0.0053] or hospitalized (AOR = 1.19, 95% CI 1.08-1.31, p = 0.0005) within a year of retransplantation if these outcomes were experienced within a year of primary transplant. Delayed graft function following primary transplants was associated with 35% increased likelihood of recurrence (AOR = 1.35, 95% CI = 1.18-1.54, p < 0.0001). An increase in 1-year GFR after primary transplant was associated with GFR 1 year postretransplant (β = 6.82, p < 0.0001), and retransplant graft failure was inversely associated with 1-year primary transplant GFR (adjusted hazard ratio = 0.74, 95% CI = 0.71-0.76 per 10 mL/min/1.73 m(2) ). A decreased likelihood for relisting was associated with hospitalization and higher GFR following primary transplantation. The increasing numbers of individuals requiring retransplants highlights the importance of incorporating prior transplant outcomes data to better inform relisting decisions and prognosticating retransplant outcomes.
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Affiliation(s)
- E L G Heaphy
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
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Trébern-Launay K, Foucher Y, Giral M, Legendre C, Kreis H, Kessler M, Ladrière M, Kamar N, Rostaing L, Garrigue V, Mourad G, Morelon E, Soulillou JP, Dantal J. Poor long-term outcome in second kidney transplantation: a delayed event. PLoS One 2012; 7:e47915. [PMID: 23110130 PMCID: PMC3479120 DOI: 10.1371/journal.pone.0047915] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/18/2012] [Indexed: 01/16/2023] Open
Abstract
Background Old studies reported a worse outcome for second transplant recipient (STR) than for first transplant recipient (FTR) mainly due to non-comparable populations with numbers confounding factors. More recent analysis, based on improved methodology by using multivariate regressions, challenged this generally accepted idea: the poor prognosis for STR is still under debate. Methodology To assess the long-term patient-and-graft survival of STR compared to FTR, we performed an observational study based on the French DIVAT prospective cohort between 1996 and 2010 (N = 3103 including 641 STR). All patients were treated with a CNI, an mTOR inhibitor or belatacept in addition to steroids and mycophenolate mofetil for maintenance therapy. Patient-and-graft survival and acute rejection episode (ARE) were analyzed using Cox models adjusted for all potential confounding factors such as pre-transplant anti-HLA immunization. Results We showed that STR have a higher risk of graft failure than FTR (HR = 2.18, p = 0.0013) but that this excess risk was observed after few years of transplantation. There was no significant difference between STR and FTR in the occurrence of either overall ARE (HR = 1.01, p = 0.9675) or steroid-resistant ARE (HR = 1.27, p = 0.4087). Conclusions The risk of graft failure following second transplantation remained consistently higher than that observed in first transplantation after adjusting for confounding factors. The rarely performed time-dependent statistical modeling may explain the heterogeneous conclusions of the literature concerning second transplantation outcomes. In clinical practice, physicians should not consider STR and FTR equally.
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Affiliation(s)
- Katy Trébern-Launay
- Institut de Transplantation Urologie Néphrologie (ITUN), Inserm U643, CHU Hôtel Dieu, Nantes, France
- Université de Nantes, EA4275 ‘Biostatistique, Recherche Clinique et Mesures Subjectives en Santé’, Nantes, France
| | - Yohann Foucher
- Institut de Transplantation Urologie Néphrologie (ITUN), Inserm U643, CHU Hôtel Dieu, Nantes, France
- Université de Nantes, EA4275 ‘Biostatistique, Recherche Clinique et Mesures Subjectives en Santé’, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), Inserm U643, CHU Hôtel Dieu, Nantes, France
| | - Christophe Legendre
- Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, France
- Universités Paris Descartes et Sorbonne Paris Cité, Paris, France
| | - Henri Kreis
- Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, France
| | - Michèle Kessler
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Marc Ladrière
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Nassim Kamar
- Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Lionel Rostaing
- Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Valérie Garrigue
- Service de Néphrologie-Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Georges Mourad
- Service de Néphrologie-Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Emmanuel Morelon
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Paul Soulillou
- Institut de Transplantation Urologie Néphrologie (ITUN), Inserm U643, CHU Hôtel Dieu, Nantes, France
- * E-mail:
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie (ITUN), Inserm U643, CHU Hôtel Dieu, Nantes, France
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11
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Dunn TB, Noreen H, Gillingham K, Maurer D, Ozturk OG, Pruett TL, Bray RA, Gebel HM, Matas AJ. Revisiting traditional risk factors for rejection and graft loss after kidney transplantation. Am J Transplant 2011; 11:2132-43. [PMID: 21812918 PMCID: PMC3184338 DOI: 10.1111/j.1600-6143.2011.03640.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Single-antigen bead (SAB) testing permits reassessment of immunologic risk for kidney transplantation. Traditionally, high panel reactive antibody (PRA), retransplant and deceased donor (DD) grafts have been associated with increased risk. We hypothesized that this risk was likely mediated by (unrecognized) donor-specific antibody (DSA). We grouped 587 kidney transplants using clinical history and single-antigen bead (SAB) testing of day of transplant serum as (1) unsensitized; PRA = 0 (n = 178), (2) third-party sensitized; no DSA (n = 363) or (3) donor sensitized; with DSA (n = 46), and studied rejection rates, death-censored graft survival (DCGS) and risk factors for rejection. Antibody-mediated rejection (AMR) rates were increased with DSA (p < 0.0001), but not with panel reactive antibody (PRA) in the absence of DSA. Cell-mediated rejection (CMR) rates were increased with DSA (p < 0.005); with a trend to increased rates when PRA>0 in the absence of DSA (p = 0.08). Multivariate analyses showed risk factors for AMR were DSA, worse HLA matching, and female gender; for CMR: DSA, PRA>0 and worse HLA matching. AMR and CMR were associated with decreased DCGS. The presence of DSA is an important predictor of rejection risk, in contrast to traditional risk factors. Further development of immunosuppressive protocols will be facilitated by stratification of rejection risk by donor sensitization.
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Affiliation(s)
- TB Dunn
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - H Noreen
- Department of Lab Medicine & Pathology, University of Minnesota, Minneapolis, Minnesota
| | - K Gillingham
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - D Maurer
- Department of Lab Medicine & Pathology, University of Minnesota, Minneapolis, Minnesota
| | - O. Goruroglu Ozturk
- Histocompatibility and Immunogenetics Lab, Emory University, Atlanta, Georgia
| | - TL Pruett
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - RA Bray
- Histocompatibility and Immunogenetics Lab, Emory University, Atlanta, Georgia
| | - HM Gebel
- Histocompatibility and Immunogenetics Lab, Emory University, Atlanta, Georgia
| | - AJ Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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12
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Guirado L, Ruiz JC, Andrés A, Rengel M, Escuin F, Ortega F, Romero R, Díaz JM, Beneyto I, Morales JM. Results of renal re-transplant in Spain (1990-2002). Clin Kidney J 2010; 3:ii37-ii40. [PMID: 20508863 PMCID: PMC2875046 DOI: 10.1093/ndtplus/sfq069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/29/2010] [Indexed: 11/13/2022] Open
Abstract
Background. Renal re-transplants are increasing in number, due to many first renal transplant patients coming back to dialysis treatment. There are controversial opinions about the evolution of these re-transplanted patients. The aim of our study is to analyse the prognosis of patients and grafts under a renal re-transplant. Methods. This was a retrospective study of 579 renal re-transplants realized in 15 Spanish different centres in the years 1990, 1994, 1998 and 2002 including all renal re-transplants realized in the above-mentioned centres during the same periods. Results. During the follow-up period, 8.81% of patients died. The actuarial patient survival was 85% at 10 years and 80% at 15 years. Principal reasons of death were the same as normal for the renal transplanted patient: cardiovascular (30.77%), infectious (13.46%) and neoplastic (13.46%). During the period of follow-up, 28.6% of the grafts were lost. The actuarial graft survival was 75% at 10 years and 58% at 15 years. Causes of graft loss are very similar to those described in literature. Conclusion. Renal re-transplant is a kind of substitute renal treatment with excellent clinical results that allow to take it as a first-order modality of treatment when the first renal transplant has failed.
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Brown KL, Doshi MD, Singh A, Mehta K, Morawski K, Cincotta E, West MS, Gruber SA. Does donor race still make a difference in deceased-donor African-American renal allograft recipients? Am J Surg 2010; 199:305-9; discussion 309. [PMID: 20226900 DOI: 10.1016/j.amjsurg.2009.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/24/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior studies have demonstrated that African-American (AA) donor kidneys are independently associated with an increased risk for graft loss. METHODS We examined outcomes in comparable groups of AA deceased-donor (DD) kidney transplant patients receiving an AA donor (n=35) versus a Caucasian donor (C group; n=150) organ. RESULTS There were no differences between AA and C groups in patient survival, new-onset diabetes, or BK nephropathy. The AA group demonstrated a significantly higher 6-month and overall incidence of acute rejection (AR), increased cytomegalovirus (CMV) infection, and decreased graft survival. Recurrent or de novo focal segmental glomerulosclerosis (FSGS) accounted for a significantly higher fraction of graft losses in the AA versus C group. CONCLUSIONS AA DD renal allograft recipients have equivalent patient but decreased graft survival when transplanted with an AA versus C kidney using current immunosuppression. This may be the result of increased AR, CMV infection, and recurrence/development of FSGS.
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Affiliation(s)
- Kristian L Brown
- Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, and Pharmacy Department, Harper University Hospital, Detroit, MI, USA
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