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Prado NP, Silva CKD, Meinerz G, Kist R, Garcia VD, Keitel E. Usefulness of Kidney Donor Profile Index (KDPI) to predict graft survival in a South Brazilian Cohort. J Bras Nefrol 2020; 42:211-218. [PMID: 32406473 PMCID: PMC7427649 DOI: 10.1590/2175-8239-jbn-2018-0263] [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: 12/21/2018] [Accepted: 12/03/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction: Kidney Donor Profile Index (KDPI) has been incorporated in the United States to improve the kidney transplant allocation system. Objectives: To evaluate deceased kidney donors’ profile using KDPI and compare to the previous United Network for Organ Sharing (UNOS) definition of expanded criteria donors (ECD) and assess the KDPI applicability to predict five-year graft survival and renal function in our sample. Methods: Retrospective cohort of 589 kidney transplants from deceased donors performed from January 2009 to May 2013 with follow-up until May 2018. Results: In 589 kidney transplants, 36.6% of donors were classified as ECD and 28.8% had KDPI ≥ 85%. Mean KDPI was 63.1 (95%CI: 60.8-65.3). There was an overlap of standard and ECD in KDPI between 60 and 95 and a significantly lower death-censored graft survival in KDPI ≥ 85% (78.6%); KDPI 0-20: 89.8%, KDPI 21-59: 91.6%, and KDPI 60-84: 83.0%; p = 0.006. The AUC-ROC was 0.577 (95%CI: 0.514-0.641; p = 0.027). Renal function at 5 years was significantly lower according to the incremental KDPI (p < 0.002). KDPI (HR 1.011; 95%CI 1.001-1.020; p = 0.008), donor-specific antibodies (HR 2.77; 95%CI 1.69-4.54; p < 0.001), acute rejection episode (HR 1.73; 95%CI 1.04-2.86; p = 0.034) were independent and significant risk factors for death-censored graft loss at 5 years. Conclusion: In our study, 36.6% were classified as ECD and 28.8% had KDPI ≥ 85%. KDPI score showed a moderate power to predict graft survival at 5 years. Renal function was significantly lower in patients with higher KDPI.
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Affiliation(s)
- Natália Petter Prado
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Nefrologia e Transplante Renal, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| | - Cynthia Keitel da Silva
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Nefrologia e Transplante Renal, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| | - Gisele Meinerz
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Nefrologia e Transplante Renal, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| | - Roger Kist
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Nefrologia e Transplante Renal, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós- Graduação em Ciências da Saúde, Porto Alegre, RS, Brasil
| | - Valter Duro Garcia
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Nefrologia e Transplante Renal, Porto Alegre, RS, Brasil
| | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Nefrologia e Transplante Renal, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
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da Silva CK, Meinerz G, Bruno RM, Abud J, Montagner J, Dorsdt DMB, Coutinho AK, Neumann J, Garcia VD, Keitel E. Late impact of preformed anti-HLA antibodies on kidney graft outcome. Transpl Immunol 2019; 55:101212. [PMID: 31254612 DOI: 10.1016/j.trim.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Cynthia Keitel da Silva
- Post Graduation Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Department of Nephrology and Kidney Transplantation, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
| | - Gisele Meinerz
- Post Graduation Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Department of Nephrology and Kidney Transplantation, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Rosana Mussoi Bruno
- Department of Nephrology and Kidney Transplantation, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Jamile Abud
- Laboratory of Transplantation Immunology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Juliana Montagner
- Laboratory of Transplantation Immunology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Jorge Neumann
- Laboratory of Transplantation Immunology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Valter Duro Garcia
- Department of Nephrology and Kidney Transplantation, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Elizete Keitel
- Post Graduation Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Department of Nephrology and Kidney Transplantation, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Loucks-DeVos JM, Eagar TN, Gaber AO, Patel SJ, Teeter LD, Graviss EA, Knight RJ. The detrimental impact of persistent vs an isolated occurrence of de novo donor-specific antibodies on intermediate-term renal transplant outcomes. Clin Transplant 2017; 31. [PMID: 28582797 DOI: 10.1111/ctr.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND De novo donor-specific antibodies (dnDSA) after renal transplant are associated with acute rejection (AR) and graft loss, yet most recipients with dnDSA have stable function and no AR. We assessed whether the persistence of dnDSA increased the risk of a detrimental outcome. METHODS A single-center review of renal transplant recipients monitored for dnDSA at multiple time points post-transplant. An Isolated dnDSA was defined as one positive dnDSA and no additional positive tests, whereas ≥2 positive dnDSA was defined as persistent dnDSA. RESULTS Of 708 recipients, 22% developed dnDSA, of whom 64% had persistent dnDSA. At median follow-up of 35 (range 12-74) months, there were fewer episodes of AR in the isolated dnDSA vs the persistent dnDSA group (2% vs 22%; P<.001,) and fewer graft losses with isolated dnDSA vs persistent dnDSA (0% vs 10%; P=.03). Within the persistent dnDSA group, recipients with dnDSA ≥60% of time points, had more AR (32% vs 16%, P=.10) and more graft losses (21% vs 2%; P=.003) than those with dnDSA<60%. CONCLUSIONS Persistence of dnDSA resulted in more AR and graft failure than a single positive value. Recipients with longer duration of dnDSA persistence had an additional increased risk of AR and graft failure.
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Affiliation(s)
| | - Todd N Eagar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Samir J Patel
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Richard J Knight
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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Richter R, Süsal C, Köhler S, Qidan S, Schödel A, Holschuh L, Brzoska M, Asbe-Vollkopf A, Büttner S, Betz C, Herrmann E, Gauer S, Seifried E, Geiger H, Seidl C, Hauser IA. Pretransplant human leukocyte antigen antibodies detected by single-antigen bead assay are a risk factor for long-term kidney graft loss even in the absence of donor-specific antibodies. Transpl Int 2016; 29:988-98. [DOI: 10.1111/tri.12786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/18/2015] [Accepted: 04/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Rudolf Richter
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
| | - Caner Süsal
- Department of Transplantation Immunology; Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - Stefanie Köhler
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Sara Qidan
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Alicia Schödel
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Lisa Holschuh
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Martin Brzoska
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Aida Asbe-Vollkopf
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Stefan Büttner
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Christoph Betz
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Eva Herrmann
- Institute for Biostatistics and Mathematical Modelling; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Stefan Gauer
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Erhard Seifried
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
| | - Helmut Geiger
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Christian Seidl
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
| | - Ingeborg A. Hauser
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
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Tang M, Wang Q, Wang J, Gao X, Wu L, Tan J. Strength of Donor-Specific Antibodies With the Use of Luminex Single-Antigen Beads Is a Reliable Predictor of Acute Rejection in Living-Relative Kidney Recipients. Transplant Proc 2015; 47:309-12. [DOI: 10.1016/j.transproceed.2014.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022]
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