Quantifying the Survival Benefit of HLA-Incompatible Kidney Transplantation: A Multi-Center Study

B. Orandi, X. Luo, A. Massie, J. Garonzik-Wang, B. Lonze, R. Ahmed, K. Van Arendonk, R. Montgomery, D. Segev.

Surgery, Hopkins, Baltimore, MD.

Meeting: 2015 American Transplant Congress

Abstract number: 193

Keywords: Alloantibodies, Highly-sensitized, Kidney transplantation, Multicenter studies

A single center study has demonstrated a two-fold survival benefit of incompatible live donor kidney transplant (ILDKT) compared to remaining on dialysis. We sought to validate these findings using data from a 22-center cohort of ILDKT patients (n=1025;185 positive Luminex, negative flow [PLNF],536 positive flow, negative cytotoxic [PFNC],304 positive complement-dependent cytotoxic crossmatch [CDC])

Table 1. Characteristics of HLA-Incompatible Live Donor Kidney Transplant (ILDKT) Recipients, By Strength of Donor-Specific Antibody

ILDKT (n=1025)
	Overall (n=1025)	Positive Luminex, Negative Flow Crossmatch (n=185)	Positive Flow, Negative Cytotoxic Crossmatch (n=536)	Positive Cytotoxic Crossmatch (n=304)
Mean Age	45.0	45.4	45.5	43.8
Female	67.0%	67.6%	68.1%	64.8%
Black	16.4%	17.3%	18.7%	11.8%
Previous Transplant	46.2%	36.8%	43.7%	56.6%
Median PRA (IQR)	66 (22-94)	51 (18-82)	57.5 (14-93)	85 (50-98)
Diabetes Mellitus	20.5%	25.4%	22.2%	14.5%
Mean Years of Dialysis	4.5	3.2	4.1	5.8
Mean Donor Age	40.7	41.6	40.5	40.5

and matching them to controls who 1) remained on dialysis only or 2) remained on dialysis or waited for a deceased donor transplant on age, blood type, PRA, renal replacement time, prior transplant, sex, diabetes, and year. The 1, 3, and 5 year survival was 95.0%, 91.7%, and 86.0% for ILDKT, 89.8%, 72.9%, and 59.1% for dialysis only, and 94.1%, 83.6%, and 74.5% for dialysis or transplant patients. By antibody strength, 1, 3, and 5 year survival for PLNF was 98.4%, 95.1%, and 91.2%, compared to 90.7%, 75.8%, and 60.8% for dialysis only and 94.5%, 85.3%, and 75.7% for dialysis or transplant patients (P<0.001). Survival for PFNC was 96.1%, 93.3%, and 87.1%, compared to 89.9%, 72.7%, and 58.5% for dialysis only and 94.6%, 84.1%, and 75.0% for dialysis or transplant patients (P<0.001). Survival for CDC was 91.1%, 86.8%, and 80.9%, compared to 89.0%, 71.5%, and 58.9% for dialysis only and 92.9%, 81.7%, and 72.7% for dialysis or transplant patients (P<0.001). Despite the challenges associated with ILDKT, this multicenter study demonstrates that patients with donor-specific antibody still experience a significant survival benefit with ILDKT.

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