Uffing, A. (Audrey) (2017) Preformed donor specific antibody class II and its effects on graft outcome after kidney transplantation. thesis, Medicine.
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Abstract
Most kidney transplant centers in the United States of America currently exclude all potential recipients with a donor-specific antibody (DSA), by listing them as unacceptable human leukocyte antigen (HLA) on the deceased donor list. However, the role of preformed DSA class II in graft outcome is not clear and its exclusion significantly reduces the chance of finding compatible donors for highly sensitized patients. In this retrospective cohort, we assessed the effect of preformed donor-specific antibodies (DSA) class II on graft outcome in 179 consecutive deceased-donor kidney transplant recipients, with a mean follow up of 4 years. Unexpectedly, we did not find a significant difference in 5-year death censored graft survival between recipients with preformed DSA class II only and recipients without DSA (adjusted HR 1.48; 95%CI: 0.49 – 4.50) (p=0.49). However, the incidence of rejection was significantly higher in recipients with DSA class II with an adjusted HR of 7.02 (95% CI: 3.02 – 16.28), mainly related to antibody-mediated rejection. Renal function, measured by creatinine levels and proteinuria 1- and 3- years post-tranpslant, did not differ between groups. Furthermore, number, type or sum mean fluorescence index (MFI) of DSA class II was not predictive of rejection, neither was epitope mismatch of AMR. In DSA class II positive recipients, basiliximab induction therapy had a significant higher incidence of AMR compared to anti-thymocyte globulin. We conclude that for patients on the waiting list who are highly sensitized and have a high risk of health-deterioration on dialysis, DSA class II should not be considered as a hard contra-indication for kidney transplantation. Careful monitoring after transplantation with preformed DSA class II is indicated because of the high incidence of AMR.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Son, Prof. dr. Willem van and University Medical Center Groningen and Department of Internal Medicine, Nefrology |
| Supervisor name: | Dr. Leonardo Riella and Brigham and Women's hospital and Department of Medicine, Renal Division and Longwood ave, 3rd floor and Boston, MA 02445 and The United States of America |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2473 |
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