Background

Living-donor kidney transplantation in cross-match (XM)-positive patients remains high-risk and requires an optimal desensitization protocol. We started a desensitization protocol for XM-positive patients in January 2012. Here we report intermediate-term outcomes in comparison with those in patients with a lower immunological risk.

Methods and objective

We performed a retrospective observational study in patients who underwent living-donor kidney transplantation between January 2012 and June 2015 in our institution. We investigated acute antibody-mediated rejection (ABMR) within 90 days postoperatively, graft function, and patient and graft survival at 3 years. All patients were stratified according to immunological risk as follows: the non-risk group was composed of DSA-negative patients; the moderate-risk group, XM-negative and DSA-positive patients; and the high-risk group, XM-positive patients.

Results

During the study period, 280 patients received living-donor kidney transplantation (non-risk group, n=230; moderate-risk group, n=35; and high-risk group, n=15). The biopsy-proven ABMR rates within 90 days after operation were 3.9% (9/230) in the non-risk group, 17.1% (6/35) in the moderate-risk group, and 60% (9/15) in the high-risk group. The ABMR rates within 90 days from transplantation were significantly highest in the high-risk group. In comparison with that in the moderate-risk group, hazard ratios were 0.07 in the non-risk group and 4.50 in the high-risk group. The estimated GFRs were 45.7±12.1, 48.9±13.6, and 37.4±11.3 mL/(min[times]1.73 m²) in the non-, moderate-, and high-risk groups at 3 years, respectively, with no significant differences. The 3-year patient survival rates were 98.7% (3 deaths), 100%, and 93.3% (1 death), respectively, with no significant differences (p=0.18). The 3-year death-censored graft survival rates were 98.7%, 97.1%, and 93.3%, respectively, with no significant differences (p=0.28).

Conclusion

The present study showed that XM-positive transplantation was comparable with lower-risk transplantation in terms of intermediate-term outcomes. Nevertheless, the incidence of postoperative ABMR is difficult to suppress despite intensive desensitization, similar to our protocol, and XM positivity is still a significant risk factor of ABMR.

CITATION INFORMATION: Okada D, Okumi M, Unagami K, Shimizu T, Ishida H, Tanabe K. Outcome of Living-Donor Kidney Transplantation in Cross-Match-Positive Recipients at a Single Center. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress