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Positive Cross‐Match Living Donor Kidney Transplantation: Longer‐Term Outcomes
Author(s) -
Haririan A.,
Nogueira J.,
Kukuruga D.,
Schweitzer E.,
Hess J.,
GurkTurner C.,
Jacobs S.,
Drachenberg C.,
Bartlett S.,
Cooper M.
Publication year - 2009
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/j.1600-6143.2008.02524.x
Subject(s) - medicine , panel reactive antibody , thymoglobulin , surgery , kidney transplantation , creatinine , transplantation , retrospective cohort study , kidney , cohort , single center
The long‐term graft outcomes after positive cross‐match (PXM) living donor kidney transplantation (LDKT) are unknown and the descriptive published data present short‐medium term results. We conducted a retrospective cohort study of LDKT with PXM by flow cytometry performed at our center during February 1999 to October 2006, compared to a control group, matched 1:1 for age, sex, race, retransplantation and transplant year. The PXM group was treated with a course of plasmapheresis/low‐dose intravenous immunoglobulin (IVIg) preoperatively, and OKT3 or thymoglobulin induction.Both groups (n = 41 each) were comparable except for duration of end‐stage renal disease (ESRD), induction, HLA mismatch and panel‐reactive antibody (PRA). During the period of up to 9 years, 14 PXM and 7 controls lost their grafts (p < 0.04). Graft survival rates at 1 and 5 years were 89.9% and 69.4% for PXM group and 97.6% and 80.6% for the controls, respectively. PXM was associated with higher risk of graft loss (HR 2.6, p = 0.04; 95%CI 1.03–6.4) (t 1/2 = 6.8 years), but not with patient survival (HR 1.96, p = 0.29; 95%CI 0.6–7.0) or 1‐year serum creatinine (β= 0.06, p = 0.59 for ln (SCr); 95% CI −0.16 to 0.28).These results suggest that despite the favorable short‐term results of PXM LDKT after PP/IVIg conditioning, medium‐long‐term outcomes are notably worse than expected, perhaps comparable to non‐ECD deceased donor kidney transplantation (KT).