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A 5 year single center review of graft survival in sensitized renal transplant recipients
S56
Abstracts
1.3 19-OR
A 5 YEAR SINGLE CENTER REVIEW OF GRAFT SURVIVAL IN SENSITIZED RENAL TRANSPLANT RECIPIENTS J.D.L. Nolen,1 R.A. Bray,1 T. Pearson,2 C. Larsen,2 K. Newell,2 K. Kokko,3 A. Guasch,3 P. Tso,2 H.M. Gebel1, 1Pathology, Emory University; 2Surgery, Emory University; 3Medicine, Emory University A third of the patients awaiting renal transplantation from deceased donors (DD) are sensitized (PRA⬎ 30%), but only 12% of this group is ultimately transplanted. Based on 2003 UNOS data, sensitized patients are transplanted at half the rate of unsensitized patients. Previous reports indicate that, compared to unsensitized patients, graft survival is significantly poorer among sensitized patients. Our transplant center performed 492 adult renal transplants from DD over the past 5 years. Approximately 25% of the recipients were sensitized, a figure double that of the national average. Detailed flow cytometric analysis for antibody specificities was performed on each patient and transplants were only performed when the flow cytometric T and B cell crossmatch was negative. Using graft failure, patient death, or GFR less than 15 mL/min/1.73 m2 as indicators, we compared graft survival/function among sensitized (n⫽120) and unsensitized (n⫽372) recipients. The 5-year survival was 70% for each group, exceeding the national average of 65.7% (OPTN/SRTR 2003 data). Our three month and one year graft survival of 97% and 92% were also above the national averages of 94% and 89%, respectively. Thus, in contrast to previously published reports, our data reveal no significant difference in graft survival/function between sensitized and unsensitized patients at any time point in the study. We believe a major factor contributing to our success among sensitized patients is the application of flow cytometric methods for antibody identification and lymphocyte crossmatching and a stringent adherence to transplanting only crossmatch negative patients.
1 20-OR
ANTI-HLA CLASS II POST-TRANSPLANT ANTIBODIES ARE ASSOCIATED WITH GRAFT LOSS DUE TO CHRONIC ALLOGRAFT NEPHROPATHY Erika F. Campos, Helio Tedesco, Jose O. Medina-Pestana, Sung I. Park, Maria Gerbase-DeLima, Pediatrics, Immunogenetics Division, Federal University of Sao Paulo UNIFESP, Sao Paulo, SP, Brazil This study was designed to evaluate the predictive value of anti-HLA antibodies (Ab) regarding graft loss due to chronic allograft nephropathy (CAN). First recipients (R) of cadaveric or non HLA-identical donors, with a functioning graft for at least 3 years after transplantation (n ⫽ 512), were evaluated for the presence of anti-HLA class I and II Ab by PRA-ELISA (One Lambda Inc), and followed from 12 to 23 months. 80% of the R received PRED/AZA/CYA. Ab to HLA class I, II and I and II were detected in 3.9, 10.7 and 3.1 % of the R, respectively. Ab positive and negative R did not differ regarding time from Tx to Ab testing, R age and race, type of donor, cold ischemia time, occurrence of delayed graft function, acute rejection, or CMV infection. Female gender, pregnancies and number of pre-Tx blood transfusions were significantly associated with the presence of class I Ab. Doubling of serum creatinine, at the time of Ab determination, in relation to the lowest post-Tx value (delta⬎ 100%) was associated with the presence of class II Ab. CAN associated graft loss was significantly higher (p ⫽ 0.03, OR2,89) in class II Ab positive R, or class II plus I Ab, compared to R with only class I Ab or Ab negative. There was no significant difference between R positive for class II and class I ⫹ II Ab. Other independent associated factors for graft loss were: delta creatinine ⬎100% at the time of Ab assessment, (p⬍0.0001, OR: 7.52), acute rejection (p⬍0.05, OR: 2.62) and R gender (male) (p⬍0.05, OR: 2.62). In conclusion, graft loss due to CAN is significantly associated with the presence of post-transplant anti-HLA class II but not anti-HLA class I antibodies.
Abstracts
1.3 19-OR
A 5 YEAR SINGLE CENTER REVIEW OF GRAFT SURVIVAL IN SENSITIZED RENAL TRANSPLANT RECIPIENTS J.D.L. Nolen,1 R.A. Bray,1 T. Pearson,2 C. Larsen,2 K. Newell,2 K. Kokko,3 A. Guasch,3 P. Tso,2 H.M. Gebel1, 1Pathology, Emory University; 2Surgery, Emory University; 3Medicine, Emory University A third of the patients awaiting renal transplantation from deceased donors (DD) are sensitized (PRA⬎ 30%), but only 12% of this group is ultimately transplanted. Based on 2003 UNOS data, sensitized patients are transplanted at half the rate of unsensitized patients. Previous reports indicate that, compared to unsensitized patients, graft survival is significantly poorer among sensitized patients. Our transplant center performed 492 adult renal transplants from DD over the past 5 years. Approximately 25% of the recipients were sensitized, a figure double that of the national average. Detailed flow cytometric analysis for antibody specificities was performed on each patient and transplants were only performed when the flow cytometric T and B cell crossmatch was negative. Using graft failure, patient death, or GFR less than 15 mL/min/1.73 m2 as indicators, we compared graft survival/function among sensitized (n⫽120) and unsensitized (n⫽372) recipients. The 5-year survival was 70% for each group, exceeding the national average of 65.7% (OPTN/SRTR 2003 data). Our three month and one year graft survival of 97% and 92% were also above the national averages of 94% and 89%, respectively. Thus, in contrast to previously published reports, our data reveal no significant difference in graft survival/function between sensitized and unsensitized patients at any time point in the study. We believe a major factor contributing to our success among sensitized patients is the application of flow cytometric methods for antibody identification and lymphocyte crossmatching and a stringent adherence to transplanting only crossmatch negative patients.
1 20-OR
ANTI-HLA CLASS II POST-TRANSPLANT ANTIBODIES ARE ASSOCIATED WITH GRAFT LOSS DUE TO CHRONIC ALLOGRAFT NEPHROPATHY Erika F. Campos, Helio Tedesco, Jose O. Medina-Pestana, Sung I. Park, Maria Gerbase-DeLima, Pediatrics, Immunogenetics Division, Federal University of Sao Paulo UNIFESP, Sao Paulo, SP, Brazil This study was designed to evaluate the predictive value of anti-HLA antibodies (Ab) regarding graft loss due to chronic allograft nephropathy (CAN). First recipients (R) of cadaveric or non HLA-identical donors, with a functioning graft for at least 3 years after transplantation (n ⫽ 512), were evaluated for the presence of anti-HLA class I and II Ab by PRA-ELISA (One Lambda Inc), and followed from 12 to 23 months. 80% of the R received PRED/AZA/CYA. Ab to HLA class I, II and I and II were detected in 3.9, 10.7 and 3.1 % of the R, respectively. Ab positive and negative R did not differ regarding time from Tx to Ab testing, R age and race, type of donor, cold ischemia time, occurrence of delayed graft function, acute rejection, or CMV infection. Female gender, pregnancies and number of pre-Tx blood transfusions were significantly associated with the presence of class I Ab. Doubling of serum creatinine, at the time of Ab determination, in relation to the lowest post-Tx value (delta⬎ 100%) was associated with the presence of class II Ab. CAN associated graft loss was significantly higher (p ⫽ 0.03, OR2,89) in class II Ab positive R, or class II plus I Ab, compared to R with only class I Ab or Ab negative. There was no significant difference between R positive for class II and class I ⫹ II Ab. Other independent associated factors for graft loss were: delta creatinine ⬎100% at the time of Ab assessment, (p⬍0.0001, OR: 7.52), acute rejection (p⬍0.05, OR: 2.62) and R gender (male) (p⬍0.05, OR: 2.62). In conclusion, graft loss due to CAN is significantly associated with the presence of post-transplant anti-HLA class II but not anti-HLA class I antibodies.