5-Yr Outcomes in Living Donor Kidney Transplants With a Positive Crossmatch

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2012.04291.x/abstract

Five-Year Outcomes in Living Donor Kidney Transplants With a Positive Crossmatch
A. Bentall1,5, L. D. Cornell2, J. M. Gloor3, W. D. Park1, M. J. Gandhi4, J. L. Winters4, M. F. Chedid1, P. G. Dean1, M. D. Stegall1,*
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)
DOI: 10.1111/j.1600-6143.2012.04291.x

Abstract

Renal transplant candidates with high levels of donor-specific anti-HLA antibodies have low transplantation rates and high mortality rates on dialysis. Using desensitization protocols, good short-term outcomes are possible in “positive crossmatch kidney transplants (+XMKTx)”, but long-term outcome data are lacking. The aim of the current study was to determine actual 5-year graft outcomes of +XMKTx. We compared graft survival and the functional and histologic status of 102 +XMKTx to 204 −XMKTx matched for age and sex. Actual 5-year death-censored graft survival was lower in the +XMKTx group (70.7% vs. 88.0%, p < 0.01) and chronic injury (glomerulopathy) was present in 54.5% of surviving grafts. Graft survival was higher in recipients with antibody against donor class I only compared with antibody against class II (either alone or in combination with class I) (85.3% vs. 62.6%, p = 0.05) and was similar to −XMKTx (85.3 vs. 88.0%, p = 0.64). Renal function and proteinuria ranged across a wide spectrum in all groups reflecting the different histological findings at 5 years. We conclude that when compared to −XMKTx, +XMKTx have inferior outcomes at 5 years, however, almost half of the surviving grafts do not have glomerulopathy and avoiding antibodies against donor class II may improve outcomes.