Specific antibodies (AB) against donor (DSA) have a fundamental role in the mechanism of kidney (K) transplant rejection and represent one of the main barriers to the success of the transplantation due to AB mediated rejection (AMR). DSA identification as a measure to prevent hyperacute and AR became a mandatory procedure in the pre-transplant immunological evaluation.We evaluated a protocol in 229 K transplants with live and deceased donors from 2009 to 2011. Recipients were classified as low, medium and high risk of rejection based on PRA- Single Antigen Bead (PRA-SAB) method to identify HLA class I, II ABs, and HLA-A, -B and -DRB1* typing for both recipients and donors. Virtual crossmatch (VXM) following real cytotoxicity dependent complement crossmatch (CDCXM) or flow cytometry (FCXM) for some patients were performed in the pre-transplant, and the graft survival was evaluated after one year. Results. 158 (69%) of the recipients before transplantation classified were non-sensitized (NS), 66 (28.82%) were sensitized without DSA, and 5(2.18%) with DSA. Those transplanted with k from living donor 129 (56.33%), from were 106 did not present rejection episodes and 23 patients had presented rejections. Of them 19 maintain K functioning and four had lost grafts. Of the 100 recipients that received K from deceased donors 66 had not experiment rejection episodes and 23 patients rejected, 16 of them had AR reversed by treatment maintained functioning K, and 7 patients lost their grafts, but 4 were by non-immunological causes. Survivals: rates were demonstrated with live donors for NS, and sensitized NDSA 97.60%, and 94.10%, respectively. For deceased donor the recipient NS, NDSA and DSA had 91,22%, 78,75% and 80,28% of one first year survival, respectively. Conclusions: Using this protocol it was possible to use accurate immunological evaluation of recipients and donors, stratifying them by risk of AMR, monitoring post transplant HLA AB to avoid AMR episodes, and thereby increasing survival.
To cite this abstract in AMA style:Abrahao S, Oliveira R, Pereira A, Junior F, Maciel M, Vilela B, Filho C, Gontijo R, Nascimento E. Kidney Transplantation: Pre and Post-Transplant Immunological Evaluation and Outcome of Recipients in Low, Medium, and High Risk of Rejection [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/kidney-transplantation-pre-and-post-transplant-immunological-evaluation-and-outcome-of-recipients-in-low-medium-and-high-risk-of-rejection/. Accessed September 24, 2017.
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