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Delayed graft function and acute rejection following HLA‐incompatible living donor kidney transplantation
Author(s) -
Motter Jennifer D.,
Jackson Kyle R.,
Long Jane J.,
Waldram Madeleine M.,
Orandi Babak J.,
Montgomery Robert A.,
Stegall Mark D.,
Jordan Stanley C.,
Benedetti Enrico,
Dunn Ty B.,
Ratner Lloyd E.,
Kapur Sandip,
Pelletier Ronald P.,
Roberts John P.,
Melcher Marc L.,
Singh Pooja,
Sudan Debra L.,
Posner Marc P.,
ElAmm Jose M.,
Shapiro Ron,
Cooper Matthew,
Verbesey Jennifer E.,
Lipkowitz George S.,
Rees Michael A.,
Marsh Christopher L.,
Sankari Bashir R.,
Gerber David A.,
Wellen Jason R.,
Bozorgzadeh Adel,
Gaber A. Osama,
Heher Eliot C.,
Weng Francis L.,
Djamali Arjang,
Helderman J. Harold,
Concepcion Beatrice P.,
Brayman Kenneth L.,
Oberholzer Jose,
Kozlowski Tomasz,
Covarrubias Karina,
Massie Allan B.,
Segev Dorry L.,
GaronzikWang Jacqueline M.
Publication year - 2021
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16471
Subject(s) - medicine , cohort , kidney transplantation , cytotoxic t cell , transplantation , desensitization (medicine) , urology , kidney , human leukocyte antigen , immunology , antigen , biochemistry , chemistry , receptor , in vitro
Incompatible living donor kidney transplant recipients (ILDKTr) 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 1406 ILDKTr to 17 542 compatible LDKT recipients (CLDKTr) 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 = 1.03 1.68 2.72 ). However, the impact of DGF on mortality and DCGF risk was no higher for ILDKT than CLDKT ( p interaction > .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 = 1.45 2.09 3.02 ; PFNC = 1.67 2.40 3.46 ; PCC = 1.48 2.24 3.37 ). Although the impact of AR on mortality was no higher for ILDKT than CLDKT ( p interaction = .1), its impact on DCGF risk was less consequential for ILDKT (aHR = 1.34 1.62 1.95 ) than CLDKT (aHR = 1.96 2.29 2.67 ) ( p interaction = .004). Providers should consider these risks during preoperative counseling, and strategies to mitigate them should be considered.