Allosensitization after transplant failure: the role of graft nephrectomy and immunosuppression – a retrospective study. (26th April 2019)

• Record Type: Journal Article
• Authors: Lucisano, Gaetano; Brookes, Paul; Santos‐Nunez, Eva; Firmin, Nicola; Gunby, Nicola; Hassan, Sevda; Gueret‐Wardle, Alexander; Herbert, Paul; Papalois, Vassilios; Willicombe, Michelle; Taube, David
• Is Part Of: Transplant international. Volume 32:Number 9(2019)
• Page Start: 949
• Page End: 959
• Publication Date: 2019-04-26
• Subjects: allosensitization -- donor‐specific antibody -- tacrolimus -- transplant nephrectomy; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13442
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: There are conflicting data about the role of transplant nephrectomy and immunosuppression withdrawal on the development of allosensitization and the impact on re‐transplantation. We divided 109 first graft recipients into two groups according to whether they underwent nephrectomy (NX+, n = 61) or their graft was left in situ (NX−, n = 48). Sera were assessed for HLA‐A/B/Cw/DR/DQ antibodies at the time of NX/transplant failure and after 3, 6, 12, 24 months. The NX+ group showed a higher rate of donor specific antibody (DSA) and non‐DSA human leukocyte antigen (HLA) antibody production at all the time points. Multivariable analysis showed that nephrectomy was a strong, independent risk factor for the development of DSAs after 12 and 24 months ( P = 0.005 and 0.008). In the NX− group, low tacrolimus levels correlated with DSA formation (AUC 0.817, P = 0.002; best cut‐off level 2.9 ng/ml). Analysis with a standardized pool of UK donors showed a more difficult grade of HLA matchability following nephrectomy compared with the NX− group. Nephrectomy is followed by the long‐term production of DSA and non‐DSA HLA antibodies and negatively impacts on the chances of finding a HLA‐compatible kidney. Tacrolimus levels ≥3 ng/ml are protective against the development of allosensitization and could facilitate re‐transplantation in the NX− group.