Delayed Graft Function and Acute Rejection Following HLA-Incompatible Living Donor Kidney Transplantation.

Dec 31, 2020

Contributor: Jennifer D Motter,Kyle R Jackson,Jane J Long,Madeleine M Waldram,Babak J Orandi,Robert A Montgomery,Mark D Stegall,Stanley C Jordan,Enrico Benedetti,Ty B Dunn,Lloyd E Ratner,Sandip Kapur,Ronald P Pelletier,John P Roberts,Marc L Melcher,Pooja Singh,Debra L Sudan,Marc P Posner,Jose M El-Amm,Ron Shapiro,Matthew Cooper,Jennifer E Verbesey,George S Lipkowitz,Michael A Rees,Christopher L Marsh,Bashir R Sankari,David A Gerber,Jason R Wellen,Adel Bozorgzadeh,A Osama Gaber,Eliot C Heher,Francis L Weng,Arjang Djamali,J Harold Helderman,Beatrice P Concepcion,Kenneth L Brayman,Jose Oberholzer,Tomasz Kozlowski,Karina Covarrubias,Allan B Massie,Dorry L Segev,Jacqueline M Garonzik-Wang

Incompatible living donor kidney transplant recipients (ILDKT) have pre-existing donor-specific antibody (DSA) that, despite desensitization, may persist or reappear with resulting consequences, including delayed graft function (DGF) and acute rejection (AR). To quantify the risk of DGF and AR in ILDKT and downstream effects, we compared 1,406 ILDKT to 17,542 compatible LDKT (CLDKT) recipients using a 25-center cohort with novel SRTR linkage. We characterized DSA strength as positive-Luminex, negative-flow crossmatch (PLNF); positive-flow, negative-cytotoxic crossmatch (PFNC); or positive-cytotoxic crossmatch (PCC). DGF occurred in 3.1% of CLDKT, 3.5% of PLNF, 5.7% of PFNC, and 7.6% of PCC recipients, which translated to higher DGF for PCC recipients (aOR= 1.68 . ). However, the impact of DGF on mortality and DCGF risk was no higher for ILDKT than CLDKT (p interaction>0.1). AR developed in 8.4% of CLDKT, 18.2% of PLNF, 21.3% of PFNC, and 21.7% of PCC recipients, which translated to higher AR (aOR PLNF= 2.09 ;PFNC= 2.40 ;PCC= 2.24 ). Although the impact of AR on mortality was no higher for ILDKT than CLDKT (p interaction=0.1), its impact on DCGF risk was less consequential for ILDKT (aHR= 1.62 ) than CLDKT (aHR= 2.29 ) (p interaction=0.004). Providers should consider these risks during pre-operative counselling, and strategies to mitigate them should be considered.
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About The Expert

Jennifer D Motter

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Kyle R Jackson

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Jane J Long

Department of Surgery, Mayo Clinic, Rochester, MN, USA.

Madeleine M Waldram

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Babak J Orandi

Department of Surgery, University of Alabama, Birmingham, AL, USA.

Robert A Montgomery

The NYU Transplant Institute, New York University Langone Medical Center, New York, NY, USA.

Mark D Stegall

Department of Surgery, Mayo Clinic, Rochester, MN, USA.

Stanley C Jordan

Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA, USA.

Enrico Benedetti

Department of Surgery, University of Illinois-Chicago, Chicago, IL, USA.

Ty B Dunn

Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Lloyd E Ratner

Department of Surgery, Columbia University Medical Center, New York, NY, USA.

Sandip Kapur

Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA.

Ronald P Pelletier

Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.

John P Roberts

Department of Surgery, University of California-San Francisco, San Francisco, CA, USA.

Marc L Melcher

Department of Surgery, Stanford University, Palo Alto, CA, USA.

Pooja Singh

Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Debra L Sudan

Department of Surgery, Duke University Medical Center, Durham, NC, USA.

Marc P Posner

Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.

Jose M El-Amm

Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK, USA.

Ron Shapiro

Recanti Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA.

Matthew Cooper

Medstar Georgetown Transplant Institute, Washington, DC, USA.

Jennifer E Verbesey

Medstar Georgetown Transplant Institute, Washington, DC, USA.

George S Lipkowitz

Department of Surgery, Baystate Medical Center Springfield, MA, USA.

Michael A Rees

Department of Urology, University of Toledo Medical Center, Toledo, OH, USA.

Christopher L Marsh

Department of Surgery, Scripps Clinic and Green Hospital, La Jolla, CA, USA.

Bashir R Sankari

Department of Urology, Cleveland Clinic, Cleveland, OH, USA.

David A Gerber

Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.

Jason R Wellen

Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO, USA.

Adel Bozorgzadeh

Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.

A Osama Gaber

Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.

Eliot C Heher

Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

Francis L Weng

Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA.

Arjang Djamali

Department of Medicine, University of Wisconsin, Madison, WI, USA.

J Harold Helderman

Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Beatrice P Concepcion

Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Kenneth L Brayman

Department of Surgery, University of Virginia, Charlottesville, VA, USA.

Jose Oberholzer

Department of Surgery, University of Virginia, Charlottesville, VA, USA.

Tomasz Kozlowski

Department of Surgery, University of Florida, Gainesville, FL, USA.

Karina Covarrubias

Department of Surgery, University of California San Diego, San Diego, CA, USA.

Allan B Massie

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Dorry L Segev

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.

Scientific Registry of Transplant Recipients, Minneapolis, MN, USA.

Jacqueline M Garonzik-Wang

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

References

PubMed