PMID- 21968524
OWN - NLM
STAT- MEDLINE
DCOM- 20111129
LR  - 20111012
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 92
IP  - 8
DP  - 2011 Oct 27
TI  - Human leukocyte antigen antibody-incompatible renal transplantation: excellent 
      medium-term outcomes with negative cytotoxic crossmatch.
PG  - 900-6
LID - 10.1097/TP.0b013e31822dc38d [doi]
AB  - BACKGROUND: Human leukocyte antigen (HLA) antibody-incompatible renal 
      transplantation has been increasingly performed since 2000 but with few data on 
      the medium-term outcomes. METHODS: Between 2003 and 2011, 84 patients received 
      renal transplants with a pretreatment donor-specific antibody (DSA) level of more 
      than 500 in a microbead assay. Seventeen patients had positive 
      complement-dependent cytotoxic (CDC) crossmatch (XM), 44 had negative CDC XM and 
      positive flow cytometric XM, and 23 had DSA detectable by microbead only. We also 
      reviewed 28 patients with HLA antibodies but no DSA at transplant. DSAs were 
      removed with plasmapheresis pretransplant, and patients did not routinely receive 
      antithymocyte globulin posttransplant. RESULTS: Mean follow-up 
      posttransplantation was 39.6 (range 2-91) months. Patient survival after the 
      first year was 93.8%. Death-censored graft survival at 1, 3, and 5 years was 
      97.5%, 94.2%, and 80.4%, respectively, in all DSA+ve patients, worse at 5 years 
      in the CDC+ve than in the CDC-ve/DSA+ve group at 45.6% and 88.6%, respectively 
      (P<0.03). Five-year graft survival in the DSA-ve group was 82.1%. Rejection 
      occurred in 53.1% of DSA+ve patients in the first year compared with 22% in the 
      DSA-ve patients (P<0.003). CONCLUSIONS: HLA antibody-incompatible renal 
      transplantation had a high success rate if the CDC XM was negative. Further work 
      is required to predict which CDC+ve XM grafts will be successful and to treat 
      slowly progressive graft damage because of DSA in the first few years after 
      transplantation.
FAU - Higgins, Robert
AU  - Higgins R
AD  - Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, West 
      Midlands, United Kingdom. Robert.Higgins@uhcw.nhs.uk
FAU - Lowe, David
AU  - Lowe D
FAU - Hathaway, Mark
AU  - Hathaway M
FAU - Williams, Clare
AU  - Williams C
FAU - Lam, For T
AU  - Lam FT
FAU - Kashi, Habib
AU  - Kashi H
FAU - Tan, Lam Chin
AU  - Tan LC
FAU - Imray, Chris
AU  - Imray C
FAU - Fletcher, Simon
AU  - Fletcher S
FAU - Chen, Klaus
AU  - Chen K
FAU - Krishnan, Nithya
AU  - Krishnan N
FAU - Hamer, Rizwan
AU  - Hamer R
FAU - Daga, Sunil
AU  - Daga S
FAU - Edey, Matthew
AU  - Edey M
FAU - Zehnder, Daniel
AU  - Zehnder D
FAU - Briggs, David
AU  - Briggs D
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA Antigens)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Graft Rejection/therapy
MH  - Graft Survival
MH  - HLA Antigens/*immunology
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Isoantibodies/blood/*immunology
MH  - *Kidney Transplantation/adverse effects/mortality
MH  - Male
MH  - Middle Aged
MH  - Proteinuria/etiology
MH  - Tissue Donors
EDAT- 2011/10/05 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/10/05 06:00
PHST- 2011/10/05 06:00 [entrez]
PHST- 2011/10/05 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - 10.1097/TP.0b013e31822dc38d [doi]
PST - ppublish
SO  - Transplantation. 2011 Oct 27;92(8):900-6. doi: 10.1097/TP.0b013e31822dc38d.