Acute Rejection and Infectious Complications in ABO- and HLA-Incompatible Kidney Transplantations

Abstract Background and Aims Kidney transplantation (KT) is considered to be the best option for renal replacement therapy (RRT) in patients with advanced chronic kidney disease, surpassing any dialysis technique in quality and life expectancy. However, results in terms of how pre-KT dialysis technique influences graft and recipient survival are mixed. Some studies show a higher incidence of vascular complications in the immediate post-transplant period and higher rates of acute rejection in patients coming from peritoneal dialysis (PD) versus those coming from hemodialysis (HD) while others observe a lower incidence of delayed graft function in the PD group of patients versus those on HD. Our objective is to analyze if there are differences in immediate post-kidney transplantation and at 6 months of follow-up depending on the pre-KT dialysis technique, PD versus HD. Method Observational study of all patients with KT of cadaveric donor from the beginning of the KT program in our Center, from August 2011 to August 2019. We analyzed the characteristics of donors and recipients according to the technique (PD/HD), the evolution and complications in the immediate post-KT, as well as results at 6 months of follow-up in terms of complications, renal function and survival of the recipient and the graft. For statistical analysis we used SPSS 25. We compared qualitative variables by means of Xi2 test, and quantitative variables by t of Student, or U of Mann-Whitney if the variables did not follow a normal distribution. A value of p <0.05 was considered significant. Results 121 patients were included, 71 of whom were in the HD group, versus 50 who were in the PD group. The recipients in the HD group were significantly older (57.2 vs 51.6 years, p 0,02) and stayed on dialysis longer (33.8 vs 26.8 months). We observed no difference in the recipient's cardiovascular history, except for increased smoking in the HD group (52.1% vs. 24%). The donor-recipient immune profile was similar in both groups. As for the incidence of delayed graft function, it was significantly lower in the PD group (14.9% vs 34.3%), finding no difference in renal function at hospital discharge or in days of admission. In the first 6 months of follow-up, we found no differences in terms of vascular, urological or infectious complications. There were also no differences in the incidence of acute rejection, renal function measured by creatinine (HD 1.47 vs DP 1.50 mg/dl) and proteinuria (HD 200 vs DP 216 mg/24 hours). Graft and recipient survival at 6 months of TR follow-up were similar in both groups. Conclusion In our experience, we have not found differences in the evolution at 6 months of the KT according to the modality of dialysis , nor greater incidence of vascular, immunological or other complications, with a survival of graft and receptor superimposable between both groups, PD or HD.

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TWO DOSE DACLIZUMAB IN PREVENTION OF ACUTE REJECTION IN LIVE DONOR KIDNEY TRANSPLANTATIONS

Transplantation Journal ◽

10.1097/01.tp.0000330658.34101.72 ◽

2008 ◽

Vol 86 (Supplement) ◽

pp. 647

Author(s):

D S. Ray

Keyword(s):

Acute Rejection ◽

Live Donor ◽

Donor Kidney ◽

Live Donor Kidney ◽

Kidney Transplantations

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Absence of Rejection in a Facial Allograft Recipient with a Positive Flow Crossmatch 24 Months after Induction with Rabbit Anti-Thymocyte Globulin and Anti-CD20 Monoclonal Antibody

Case Reports in Transplantation ◽

10.1155/2018/7691072 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Bruce E. Gelb ◽

J. Rodrigo Diaz-Siso ◽

Natalie M. Plana ◽

Adam Jacoby ◽

William J. Rifkin ◽

...

Keyword(s):

Acute Rejection ◽

Human Leukocyte ◽

Infectious Complications ◽

High Rate ◽

Early Results ◽

Maintenance Immunosuppression ◽

Facial Burns ◽

Successful Transplantation ◽

Transplant Candidates ◽

Anti Cd20

Background. Donor-specific antibodies (DSA) to human leukocyte antigen increase the risk of accelerated rejection and allograft damage and reduce the likelihood of successful transplantation. Patients with full-thickness facial burns may benefit from facial allotransplantation. However, they are at a high risk of developing DSA due to standard features of their acute care. Case Presentation. A 41-year-old male with severe disfigurement from facial burns consented to facial allotransplantation in 2014; panel reactive antibody score was 0%. In August of 2015, a suitable donor was found. Complement-dependent cytotoxicity crossmatch was negative; flow cytometry crossmatch was positive to donor B cells. An induction immunosuppression strategy consisting of rabbit antithymocyte globulin, rituximab, tacrolimus, mycophenolate mofetil (MMF), and methylprednisolone taper was designed. Total face, scalp, eyelid, ears, and skeletal subunit allotransplantation was performed without operative, immunological, or infectious complications. Maintenance immunosuppression consists of tacrolimus, MMF, and prednisone. As of posttransplant month 24, the patient has not developed acute rejection or metabolic or infectious complications. Conclusions. To our knowledge, this is the first report of targeted B cell agents used for induction immunosuppression in skin-containing vascularized composite tissue allotransplantation. A cautious approach is warranted, but early results are promising for reconstructive transplant candidates given the exceptionally high rate of acute rejection episodes, particularly in the first year, in this patient population.

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Delayed Graft Function and Acute Rejection Following HLA‐Incompatible Living Donor Kidney Transplantation

American Journal of Transplantation ◽

10.1111/ajt.16471 ◽

2020 ◽

Author(s):

Jennifer D. Motter ◽

Kyle R. Jackson ◽

Jane J. Long ◽

Madeleine M. Waldram ◽

Babak J. Orandi ◽

...

Keyword(s):

Kidney Transplantation ◽

Acute Rejection ◽

Living Donor ◽

Graft Function ◽

Delayed Graft Function ◽

Donor Kidney ◽

Living Donor Kidney Transplantation ◽

Hla Incompatible ◽

Donor Kidney Transplantation ◽

Living Donor Kidney

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Kidney Transplantation - New Developments

Swiss Surgery ◽

10.1024/1023-9332.9.5.205 ◽

2003 ◽

Vol 9 (5) ◽

pp. 205-212 ◽

Cited By ~ 3

Author(s):

Dahm ◽

Weber

Keyword(s):

Kidney Transplantation ◽

Renal Disease ◽

De Novo ◽

Preoperative Assessment ◽

Infectious Complications ◽

Living Donation ◽

Organ Shortage ◽

Prophylactic Measures ◽

Kidney Transplantations ◽

Over Time

The standard of care for patients with end-stage renal disease is kidney transplantation, which not only confers a survival benefit compared to hemodialysis, but is also cost-effective. The indications, contraindications as well as the preoperative assessment of recipients are discussed. The recurrence rate of the underlying renal disease has to be taken into account, especially in living donation. Growing organ shortage has lead transplant surgeons to accept older, less healthy, and even non-heart-beating donors, with generally good results. Living-donation is safe for the donor, outcome is excellent and plays an increasing role today. It has surpassed the number of cadaveric kidney transplantations in some countries. Many centres now apply laparoscopic donor nephrectomy with low morbidity. Matching for ABO blood group and HLA is routinely performed, as well as pre-transplant crossmatching. The surgical procedure has been standardized and the complication rate is low. Immunosuppressive protocols have evolved over time, and while the optimal regimen has not been defined, the availability of numerous agents allows the regimen to be individualized. New agents are being introduced into clinical practice. With increasing long-term graft survival and thus life-long immunosuppression, cardiovascular disease, de-novo malignancies and infectious complications are major causes of morbidity and mortality of transplant recipients. Effective prophylactic measures are often available, and surveillance protocols are warranted in these patients. Overall, the outcome of renal transplantation is excellent and has improved over time. Future prospects include induction of allograft tolerance, tissue engineering and xenotransplantation.

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Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis

AIDS Research and Therapy ◽

10.1186/s12981-019-0253-z ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Xin Zheng ◽

Lian Gong ◽

Wenrui Xue ◽

Song Zeng ◽

Yue Xu ◽

...

Keyword(s):

Systematic Review ◽

Kidney Transplantation ◽

Antiretroviral Therapy ◽

Acute Rejection ◽

Kidney Transplant ◽

Graft Survival ◽

Patient Survival ◽

Meta Analysis ◽

Infectious Complications ◽

Hiv Positive

Abstract Background Kidney transplantation is now a viable alternative to dialysis in HIV-positive patients who achieve good immunovirological control with the currently available antiretroviral therapy regimens. This systematic review and meta-analysis investigate the published evidence of outcome and risk of kidney transplantation in HIV-positive patients following the PRISMA guidelines. Methods Searches of PubMed, the Cochrane Library and EMBASE identified 27 cohort studies and 1670 case series evaluating the survival of HIV-positive kidney transplant patients published between July 2003 and May 2018. The regimens for induction, maintenance therapy and highly active antiretroviral therapy, acute rejection, patient and graft survival, CD4 count and infectious complications were recorded. We evaluated the patient survival and graft survival at 1 and 3 years respectively, acute rejection rate and also other infectious complications by using a random-effects analysis. Results At 1 year, patient survival was 0.97 (95% CI 0.95; 0.98), graft survival was 0.91 (95% CI 0.88; 0.94), acute rejection was 0.33 (95% CI 0.28; 0.38), and infectious complications was 0.41 (95% CI 0.34; 0.50), and at 3 years, patient survival was 0.94 (95% CI 0.90; 0.97) and graft survival was 0.81 (95% CI 0.74; 0.87). Conclusions With careful selection and evaluation, kidney transplantation can be performed with good outcomes in HIV-positive patients.

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Modest dose anti-thymocyte globulin administered intraoperatively is safe and effective in kidney transplantations: a retrospective study

PeerJ ◽

10.7717/peerj.7274 ◽

2019 ◽

Vol 7 ◽

pp. e7274 ◽

Cited By ~ 1

Author(s):

Hui-Ying Liu ◽

Yuan-Tso Cheng ◽

Hao Lun Luo ◽

Chiang-Chi Huang ◽

Chien Hsu Chen ◽

...

Keyword(s):

Acute Rejection ◽

Induction Therapy ◽

Dose Regimen ◽

Low Dose ◽

Graft Loss ◽

Graft Function ◽

Calcineurin Inhibitors ◽

Kidney Transplant Recipients ◽

Significant Difference ◽

Kidney Transplantations

Background Anti-thymocyte globulin (ATG) as induction therapy in renal transplantation is facing the dilemma of reducing the incidence of acute rejection (AR) and delayed graft function (DGF) or increasing risks of infection and malignancy. The purpose of this study was to delineate the safety and efficiency of the optimal ATG dosage. Methods We retrospectively evaluated 91 deceased donor kidney transplant recipients (KTRs) in our institution between March 2011 and January 2019. The patients were classified into three groups based on induction therapy: (1) Group 1: modest-dose ATG (three mg/kg) intraoperatively (N = 21); (2) Group 2: low-dose ATG (1–1.5 mg/kg) intraoperatively (N = 23); (3) Group 3: basiliximab 20 mg both on day 0 and 4 (N = 47). In Groups 1 and 2, all patients received a daily low-dose program (1–1.5 mg/kg each day) with target dosage of six mg/kg. Induction therapy was combined with standard immunosuppressive regimen consisting of calcineurin inhibitors, mycophenolate/the mammalian target of rapamycin inhibitors and corticosteroids. Results There was no significant difference in patient characteristics among groups. The outcomes of infection rate, biopsy-proven acute rejection, post-transplant diabetes mellitus, graft survival, and patient survival were similar among groups. Compared to the daily low-dose ATG regimen, the intraoperative modest-dose regimen did not cause more dose interruption and hence was more likely to reach the target ATG dosage. The intraoperative modest-dose regimen also seemed to reduce the rate of DGF. Discussion In recent years, a trend of using a “lower” dose of ATG has seemed to emerge. Our results suggest intraoperative modest-dose ATG followed by daily low-dose ATG regimen was safe and effective in cadaveric renal transplantations for preventing DGF, AR, and graft loss.

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