Difference in outcomes after antibody‐mediated rejection between abo‐incompatible and positive cross‐match transplantations. (6th July 2015)

• Record Type: Journal Article
• Authors: Couzi, Lionel; Manook, Miriam; Perera, Ranmith; Shaw, Olivia; Ahmed, Zubir; Kessaris, Nicos; Dorling, Anthony; Mamode, Nizam
• Is Part Of: Transplant international. Volume 28:Number 10(2015:Oct.)
• Page Start: 1205
• Page End: 1215
• Publication Date: 2015-07-06
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.12621
• Languages: English
• ISSNs: 0934-0874

Abstract

<abstract abstract-type="main" id="tri12621-abs-0001"> <title>Summary</title> <p>Graft survival seems to be worse in positive cross‐match (HLAi) than in ABO‐incompatible (ABOi) transplantation. However, it is not entirely clear why these differences exist. Sixty‐nine ABOi, 27 HLAi and 10 combined ABOi+HLAi patients were included in this retrospective study, to determine whether the frequency, severity and the outcome of active antibody‐mediated rejection (AMR) were different. Five‐year death‐censored graft survival was better in ABOi than in HLAi and ABOi+HLAi patients (99%, 69% and 64%, respectively, <italic>P</italic> = 0.0002). Features of AMR were found in 38%, 95% and 100% of ABOi, HLAi and ABOi+HLAi patients that had a biopsy, respectively (<italic>P</italic> = 0.0001 and <italic>P</italic> = 0.001). After active AMR, a declining eGFR and graft loss were observed more frequently in HLAi and HLAi+ABOi than in ABOi patients. The poorer prognosis after AMR in HLAi and ABOi+HLAi transplantations was not explained by a higher severity of histological lesions or by a less aggressive treatment. In conclusion, ABOi transplantation offers better results than HLAi transplantation, partly because AMR occurs less frequently but also because outcome after AMR is distinctly better. HLAi and combined ABOi+HLAi transplantations appear to have the same outcome, suggesting there is no synergistic effect between anti‐A/B and anti‐HLA antibodies.</p> </abstract>