Five-Year Outcomes in Living Donor Kidney Transplants With a Positive Crossmatch
Five-Year Outcomes in Living Donor Kidney Transplants With a Positive Crossmatch
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DOI：
10.1111/j.1600-6143.2012.04291.x
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发表时间：
2013-01-01
影响因子：
8.8
通讯作者：
Stegall, M. D.
中科院分区：
文献类型：
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作者：
Bentall, A.;Cornell, L. D.;Stegall, M. D.
具有高水平供体特异性抗HLA抗体的肾移植候选者具有低移植率和高透析死亡率。使用脱敏方案，阳性交叉配型肾移植（+XMKTx）可能会产生良好的短期结果，但缺乏长期结果数据。本研究的目的是确定+XMKTx的实际5年移植结局。我们比较了年龄和性别匹配的102 +XMKTx和204 -XMKTx的移植物存活率和功能及组织学状态。+XMKTx组中实际5年死亡删失移植物存活率较低（70.7%对88.0%，p < 0.01），54.5%的存活移植物存在慢性损伤（肾小球病）。移植物存活率在仅具有抗供体I类抗体的受体中高于抗II类抗体（单独或与I类抗体组合）（85.3%对62.6%，p = 0.05），并且与-XMKTx相似（85.3%对88.0%，p = 0.64）。所有组的肾功能和蛋白尿范围广泛，反映了5年时不同的组织学结果。我们得出结论，当与-XMKTx相比，+XMKTx在5年时具有较差的结局，然而，几乎一半的存活移植物没有肾小球病，避免针对供体II类的抗体可能会改善结局。
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.