Induction and Donor Specific Antibodies in Low Immunologic Risk Kidney Transplant Recipients

被引:7
作者
Bath, Natalie M. [1 ]
Djamali, Arjang [2 ]
Parajuli, Sandesh [2 ]
Mandelbrot, Didier [2 ]
Leverson, Glen [3 ]
Hidalgo, Luis [1 ]
Ellis, Thomas [4 ]
Descourouez, Jillian L. [1 ]
Jorgenson, Margaret R. [1 ]
Hager, Dave [1 ]
Kaufman, Dixon B. [1 ]
Redfield, Robert R., III [1 ]
机构
[1] Univ Wisconsin Hosp & Clin, Dept Surg, Div Transplant, Madison, WI 53792 USA
[2] Univ Wisconsin Hosp & Clin, Dept Med, Div Nephrol, Madison, WI USA
[3] Univ Wisconsin Hosp & Clin, Dept Surg, Madison, WI 53792 USA
[4] Univ Wisconsin Hosp & Clin, Dept Pathol & Lab Med, Madison, WI USA
来源
KIDNEY360 | 2020年 / 1卷 / 12期
关键词
transplantation; antibodies; donor specific antibody; induction; kidney transplantation; tissue donors; RABBIT ANTITHYMOCYTE GLOBULIN; BASILIXIMAB INDUCTION; HLA; ALEMTUZUMAB; IMMUNOSUPPRESSION; THYMOGLOBULIN; REJECTION; BIOPSIES; THERAPY; TRIAL;
D O I
10.34067/KID.0000122020
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Optimal induction for patients without pretransplant donor-specific antibodies (DSAs) is poorly defined. The goal of this study was to compare the incidence of de novo DSA (dnDSA) and graft outcomes between induction therapies in patients with a negative virtual crossmatch (VXM). Methods A retrospective chart review was performed, identifying 782 patients with a negative VXM who underwent kidney transplantation at a single, high-volume institution between January 2013 and May 2017. Kaplan-Meier analysis was used to assess the incidence of dnDSA and allograft survival between induction therapies in this group. dnDSA is defined as the development of new post-transplant DSA, at any MFI level. Results Induction therapy included alemtuzumab (N=87, 11%), basiliximab (N=522, 67%), and anti-thymocyte globulin (ATG; N=173, 22%). One-year graft survival was similar between groups (alemtuzumab, 100%; basiliximab, 98%; ATG, 99%). Incidence of acute rejection at 1 year was < 2% and not different between the three groups. Alemtuzumab was associated with the highest incidence of dnDSA at 14%, compared with 5% and 8% in basiliximab and ATG groups, respectively, at 1 year (P=0.009). In multivariate regression analyses, alemtuzumab retained its significant association with a dnDSA HR of 2.5 (95% CI, 1.51 to 4.25; P=0.0004). Conclusions In summary, alemtuzumab was associated with a higher rate of dnDSA development in patients with a negative VXM; however, this finding was not associated with rejection or graft failure.
引用
收藏
页码:1407 / 1418
页数:12
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