Date: Sunday, April 30, 2017
Session Name: Concurrent Session: Kidney: Acute Cellular Rejection
Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Purpose: We aimed to describe the immunosuppressive regimens and graft rejection rates in living-related HLA-identical (LR HLAid) renal transplantation.
Methods: We performed a retrospective multicenter analysis of the Cristal database (Agence de la Biomédecine) for LR HLAid renal transplantations performed between January 2002 and December 2012. Univariate and multivariate analysis were performed to determine risk factors for graft rejection in LR HLAid recipients.
Results: From 2002 to 2012, 27218 renal transplantations were performed in France, including 2475 transplantations from living donors, of whom 163 had a LR HLAid donor. In 21 out of these 163 patients (12.9%) a diagnosis of biopsy-proven acute rejection was made. The patients with rejection were younger (median 32 versus 42 y, p=0.03) than the non rejecting patients. They had also more frequently detectable anti-HLA antibodies after transplantation (38% versus 19.7%, p=0.03). There was no significant difference concerning sex ratio, previous transplant history, initial renal disease, length of dialysis, rate of complications. Less than 60% of the whole cohort had induction therapy with polyclonal or monoclonal antibodies. On the long term, 29% of the patients in both groups did not receive CNI, and 35 to 43% did not receive steroids. Rejection occurred on an average of 24 months after transplantation, in 28.5% of the cases after minimization of immunosuppression. The differences for patient survival, graft survival rates and graft function were not statistically significant between both groups of patients at 1, 5 and 10 years post transplantation.
Conclusion: Minimization of immunosuppression should be cautious in LR HLAid renal transplantations, especially in young recipients. Genomic analysis may help identify the tissue antigens, other than HLA, that drive the rejection process in these cases.
CITATION INFORMATION: Ossman R, Jamme M, Galichon P, Hertig A, Moulin B, Legendre C, Morelon E, Taupin J.-L, Rostaing L, Rondeau E. Immunosuppression and Graft Rejection in Living-Related HLA-Identical Renal Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Ossman R, Jamme M, Galichon P, Hertig A, Moulin B, Legendre C, Morelon E, Taupin J-L, Rostaing L, Rondeau E. Immunosuppression and Graft Rejection in Living-Related HLA-Identical Renal Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). http://atcmeetingabstracts.com/abstract/immunosuppression-and-graft-rejection-in-living-related-hla-identical-renal-transplantation/. Accessed January 17, 2018.
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