ABO Incompatible Kidney Transplantation Without B-cell Depletion is Associated With Increased Early Acute Rejection: A Single-Center Australian Experience

被引：3
作者：
Bleasel, Jonathan M. [1 ]
Wan, Susan S. [1 ,2 ]
Chadban, Steven J. [1 ,2 ,3 ]
Ying, Tracey [1 ,2 ,3 ]
Gracey, David M. [1 ,3 ]
Aouad, Leyla J. [1 ,2 ,3 ]
Chen, Qian-Ao [3 ]
Utsiwegota, Mike [1 ]
Mawson, Jane [1 ]
Wyburn, Kate R. [1 ,2 ,3 ]
机构：
[1] Royal Prince Alfred Hosp, Dept Renal Med, Sydney, NSW, Australia
[2] Univ Sydney, Charles Perkins Ctr, Kidney Node, Sydney, NSW, Australia
[3] Univ Sydney, Fac Med & Hlth, Cent Clin Sch, Sydney, NSW, Australia
来源：
TRANSPLANT INTERNATIONAL | 2023年 / 36卷
关键词：
ABO incompatible; kidney transplantation; rituximab; immunosuppression; rejection; ANTIGEN-SPECIFIC IMMUNOADSORPTION; RENAL-TRANSPLANTATION; CLINICAL-OUTCOMES; ANTIBODY REMOVAL; RITUXIMAB; SPLENECTOMY; COMPLICATIONS;
D O I：
10.3389/ti.2023.11567
中图分类号：
R61 [外科手术学];
学科分类号：
摘要：
We performed a single-center retrospective cohort study of 66 consecutive ABO incompatible kidney transplants (ABOiKT) performed without B-cell depleting therapy. Outcomes were compared to an earlier era performed with rituximab (n = 18) and a contemporaneous cohort of ABO compatible live donor transplants (ABOcKT). Acute rejection within 3 months of transplant was significantly more common after rituximab-free ABOiKT compared to ABOiKT with rituximab (OR 8.8, p = 0.04) and ABOcKT (OR 2.9, p = 0.005) in adjusted analyses. Six recipients of rituximab-free ABOiKT experienced refractory antibody mediated rejection requiring splenectomy, and a further two incurred early graft loss with no such episodes amongst ABOiKT with rituximab or ABOcKT cohorts. Patient and graft survival were similar between groups over a median follow-up of 3.1 years. This observational evidence lends strong support to the continued inclusion of rituximab in desensitization protocols for ABOiKT.
引用
收藏
页数：8
相关论文
共 31 条
[1]  
American Society of Histocompatibility and Immunogenetics (ASHI), 2019, Standards for Accredited Laboratories
[2]   Economic Impacts of ABO-Incompatible Live Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients [J].
Axelrod, D. ;
Segev, D. L. ;
Xiao, H. ;
Schnitzler, M. A. ;
Brennan, D. C. ;
Dharnidharka, V. R. ;
Orandi, B. J. ;
Naik, A. S. ;
Randall, H. ;
Tuttle-Newhall, J. E. ;
Lentine, K. L. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2016, 16 (05) :1465-1473
[3]   Histological and Extended Clinical Outcomes After ABO-Incompatible Renal Transplantation Without Splenectomy or Rituximab [J].
Chow, Kevin V. ;
Flint, Shaun M. ;
Shen, Angeline ;
Landgren, Anthony ;
Finlay, Moira ;
Murugasu, Anand ;
Masterson, Rosemary ;
Hughes, Peter ;
Cohney, Solomon J. .
TRANSPLANTATION, 2017, 101 (06) :1433-1440
[4]   ABO-incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies: a propensity-matched analysis [J].
de Weerd, Annelies E. ;
van den Brand, Jan A. J. G. ;
Bouwsma, Hanneke ;
de Vries, Aiko P. J. ;
Dooper, Ine M. M. ;
Sanders, Jan-Stephan F. ;
Christiaans, Maarten H. L. ;
van Reekum, Franka E. ;
van Zuilen, Arjan D. ;
Bemelman, Frederike J. ;
Nurmohamed, Azam S. ;
van Agteren, Madelon ;
Betjes, Michiel G. H. ;
de Jong, Margriet F. C. ;
Baas, Marije C. .
TRANSPLANT INTERNATIONAL, 2021, 34 (12) :2706-2719
[5]   ABO-Incompatible Kidney Transplant Outcomes A Meta-Analysis [J].
de Weerd, Annelies E. ;
Betjes, Michiel G. H. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2018, 13 (08) :1234-1243
[6]   Successful ABO-Incompatible Kidney Transplantation with Antibody Removal and Standard Immunosuppression [J].
Flint, S. M. ;
Walker, R. G. ;
Hogan, C. ;
Haeusler, M. N. ;
Robertson, A. ;
Francis, D. M. A. ;
Millar, R. ;
Finlay, M. ;
Landgren, A. ;
Cohney, S. J. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2011, 11 (05) :1016-1024
[7]   ABO-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab:: A 3-year follow-up [J].
Genberg, Helena ;
Kumlien, Gunilla ;
Wennberg, Lars ;
Berg, Ulla ;
Tyden, Gunnar .
TRANSPLANTATION, 2008, 85 (12) :1745-1754
[8]   The REDCap consortium: Building an international community of software platform partners [J].
Harris, Paul A. ;
Taylor, Robert ;
Minor, Brenda L. ;
Elliott, Veida ;
Fernandez, Michelle ;
O'Neal, Lindsay ;
McLeod, Laura ;
Delacqua, Giovanni ;
Delacqua, Francesco ;
Kirby, Jacqueline ;
Duda, Stephany N. .
JOURNAL OF BIOMEDICAL INFORMATICS, 2019, 95
[9]   Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support [J].
Harris, Paul A. ;
Taylor, Robert ;
Thielke, Robert ;
Payne, Jonathon ;
Gonzalez, Nathaniel ;
Conde, Jose G. .
JOURNAL OF BIOMEDICAL INFORMATICS, 2009, 42 (02) :377-381
[10]   Effect of Rituximab Used as Induction in Patients with ABO Mismatch Kidney Transplant: A Systematic Review and Meta-analysis [J].
Hwang, Seun Deuk ;
Lee, Jin Ho ;
Kim, Kipyo ;
Lee, Seoung Woo ;
Song, Joon Ho .
TRANSPLANTATION PROCEEDINGS, 2020, 52 (10) :3125-3128
1234