TY - JOUR
T1 - Delayed graft function and acute rejection following HLA-incompatible living donor kidney transplantation
AU - Motter, Jennifer D.
AU - Jackson, Kyle R.
AU - Long, Jane J.
AU - Waldram, Madeleine M.
AU - Orandi, Babak J.
AU - Montgomery, Robert A.
AU - Stegall, Mark D.
AU - Jordan, Stanley C.
AU - Benedetti, Enrico
AU - Dunn, Ty B.
AU - Ratner, Lloyd E.
AU - Kapur, Sandip
AU - Pelletier, Ronald P.
AU - Roberts, John P.
AU - Melcher, Marc L.
AU - Singh, Pooja
AU - Sudan, Debra L.
AU - Posner, Marc P.
AU - El-Amm, Jose M.
AU - Shapiro, Ron
AU - Cooper, Matthew
AU - Verbesey, Jennifer E.
AU - Lipkowitz, George S.
AU - Rees, Michael A.
AU - Marsh, Christopher L.
AU - Sankari, Bashir R.
AU - Gerber, David A.
AU - Wellen, Jason R.
AU - Bozorgzadeh, Adel
AU - Gaber, A. Osama
AU - Heher, Eliot C.
AU - Weng, Francis L.
AU - Djamali, Arjang
AU - Helderman, J. Harold
AU - Concepcion, Beatrice P.
AU - Brayman, Kenneth L.
AU - Oberholzer, Jose
AU - Kozlowski, Tomasz
AU - Covarrubias, Karina
AU - Massie, Allan B.
AU - Segev, Dorry L.
AU - Garonzik-Wang, Jacqueline M.
N1 - Funding Information:
The authors would like to thank all the transplant centers that generously provided data on their ILDKT patients. We would also like to thank the co‐investigators, coordinators, and research staff who contributed to this study. This work was supported by grant numbers F32DK113719 (Jackson), K01DK101677 (Massie), R01DK98431 (Segev), K24DK101828 (Segev), and K23DK115908 (Garonzik‐Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr. Orandi is supported by the National Center for Advancing Translational Sciences grant number 1KL2TR003097. Dr. Garonzik‐Wang is supported by a Clinician Scientist Development Award from the Doris Duke Charitable Research Foundation. The data reported here have been supplied by the Hennepin Healthcare Research Institute as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor do mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/4
Y1 - 2021/4
N2 - 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 = 1.031.682.72). 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 = 1.452.093.02; PFNC = 1.672.403.46; PCC = 1.482.243.37). 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 = 1.341.621.95) than CLDKT (aHR = 1.962.292.67) (p interaction =.004). Providers should consider these risks during preoperative counseling, and strategies to mitigate them should be considered.
AB - 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 = 1.031.682.72). 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 = 1.452.093.02; PFNC = 1.672.403.46; PCC = 1.482.243.37). 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 = 1.341.621.95) than CLDKT (aHR = 1.962.292.67) (p interaction =.004). Providers should consider these risks during preoperative counseling, and strategies to mitigate them should be considered.
KW - clinical research/practice
KW - delayed graft function (DGF)
KW - desensitization
KW - graft survival
KW - histocompatibility
KW - kidney transplantation/nephrology
KW - patient survival
KW - rejection: acute
UR - http://www.scopus.com/inward/record.url?scp=85101966820&partnerID=8YFLogxK
U2 - 10.1111/ajt.16471
DO - 10.1111/ajt.16471
M3 - Article
C2 - 33370502
AN - SCOPUS:85101966820
SN - 1600-6135
VL - 21
SP - 1612
EP - 1621
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 4
ER -