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2017 ; 3
(7
): e181
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
The UK National Registry of ABO and HLA Antibody Incompatible Renal
Transplantation: Pretransplant Factors Associated With Outcome in 879
Transplants
#MMPMID28706984
Pankhurst L
; Hudson A
; Mumford L
; Willicombe M
; Galliford J
; Shaw O
; Thuraisingham R
; Puliatti C
; Talbot D
; Griffin S
; Torpey N
; Ball S
; Clark B
; Briggs D
; Fuggle SV
; Higgins RM
Transplant Direct
2017[Jul]; 3
(7
): e181
PMID28706984
show ga
BACKGROUND: ABO and HLA antibody incompatible (HLAi) renal transplants (AIT) now
comprise around 10% of living donor kidney transplants. However, the relationship
between pretransplant factors and medium-term outcomes are not fully understood,
especially in relation to factors that may vary between centers. METHODS: The
comprehensive national registry of AIT in the United Kingdom was investigated to
describe the donor, recipient and transplant characteristics of AIT. Kaplan-Meier
analysis was used to compare survival of AIT to all other compatible kidney
transplants performed in the United Kingdom. Cox proportional hazards regression
modeling was used to determine which pretransplant factors were associated with
transplant survival in HLAi and ABOi separately. The primary outcome was
transplant survival, taking account of death and graft failure. RESULTS: For 522
HLAi and 357 ABO incompatible (ABOi) transplants, 5-year transplant survival
rates were 71% (95% confidence interval [CI], 66-75%) for HLAi and 83% (95% CI,
78-87%) for ABOi, compared with 88% (95% CI, 87-89%) for 7290 standard living
donor transplants, and 78% (95% CI, 77-79%) for 15 322 standard deceased donor
transplants (P < 0.0001). Increased chance of transplant loss in HLAi was
associated with increasing number of donor specific HLA antibodies, center
performing the transplant, antibody level at the time of transplant, and an
interaction between donor age and dialysis status. In ABOi, transplant loss was
associated with no use of IVIg, cytomegalovirus seronegative recipient, 000 HLA
donor-recipient mismatch; and increasing recipient age. CONCLUSIONS: Results of
AIT were acceptable, certainly in the context of a choice between living donor
AIT and an antibody compatible deceased donor transplant. Several factors were
associated with increased chance of transplant loss, and these can lead to
testable hypotheses for further improving therapy.