scholarly journals Can PIRCHE-II Matching Outmatch Traditional HLA Matching?

2021 ◽  
Vol 12 ◽  
Author(s):  
Christian Unterrainer ◽  
Bernd Döhler ◽  
Matthias Niemann ◽  
Nils Lachmann ◽  
Caner Süsal
Keyword(s):  
Positive Impact ◽  
Graft Loss ◽  
Deceased Donor ◽  
Hla Typing ◽  
Hla Matching ◽  
Hla Antigen ◽  
Deceased Donor Kidney ◽  
Resolution Level ◽  
Kidney Transplantations ◽  
Hla Mismatches

We analyzed in a cohort of 68,606 first deceased donor kidney transplantations reported to the Collaborative Transplant Study whether an epitope-based matching of donor-recipient pairs using the Predicted Indirectly ReCognizable HLA Epitopes algorithm (PIRCHE-II) is superior to currently applied HLA antigen matching. PIRCHE-II scores were calculated based on split antigen HLA-A, -B, -DRB1 typing and adjusted to the 0–6 range of HLA mismatches. PIRCHE-II scores correlated strongly with the number of HLA mismatches (Spearman ρ = 0.65, P < 0.001). In multivariable analyses both parameters were found to be significant predictors of 5-year death-censored graft loss with high prognostic power [hazard ratio (HR) per adjusted PIRCHE-II score = 1.102, per HLA mismatch = 1.095; z-value PIRCHE-II: 9.8, HLA: 11.2; P < 0.001 for both]. When PIRCHE-II scores and HLA mismatches were analyzed simultaneously, their predictive power decreased but remained significant (PIRCHE-II: P = 0.002; HLA: P < 0.001). Influence of PIRCHE-II was especially strong in presensitized and influence of HLA mismatches in non-sensitized recipients. If the level of HLA-incompatibility was low (0–3 mismatches), PIRCHE-II scores showed a low impact on graft survival (HR = 1.031) and PIRCHE-II matching did not have additional significant benefit (P = 0.10). However, if the level of HLA-incompatibility was high (4–6 mismatches), PIRCHE-II improved the positive impact of matching compared to applying the traditional HLA matching alone (HR = 1.097, P = 0.005). Our results suggest that the PIRCHE-II score is useful and can be included into kidney allocation algorithms in addition to HLA matching; however, at the resolution level of HLA typing that is currently used for allocation it cannot fully replace traditional HLA matching.

scholarly journals Outcomes of Deceased Donor Kidney Transplantation in the Eurotransplant Senior Program with A Focus on Recipients ≥75 Years

2021 ◽  
Vol 10 (23) ◽  
pp. 5633
Author(s):  
Ilias Zompolas ◽  
Robert Peters ◽  
Lutz Liefeldt ◽  
Lukas J. Lehner ◽  
Klemens Budde ◽  
...  
Keyword(s):  
Risk Factor ◽  
Kidney Transplantation ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Kidney Transplantations ◽  
Esrd Patients ◽  
Donor Kidney Transplantation ◽  
Eurotransplant Senior Program ◽  
Deceased Donor Kidney Transplantation

To evaluate the outcomes of kidney transplantations (KTs) in the Eurotransplant Senior Program (ESP) with a focus on the very old, defined as recipients ≥75 years. This retrospective clinical study included 85 patients, who under the ESP protocol underwent deceased donor kidney transplantation from January 2010 to July 2018 at the Charité–Universitätsmedizin Berlin in Germany. Recipients were divided in three age groups, i.e., Group 65–69, Group 70–74, Group ≥75, and compared. Prognostic risk factors for short and long-term outcomes of kidney transplantations were investigated. Graft survival at 1 and 5 years were respectively 90.7% and 68.0% for group 65–69, 88.9% and 76.2% for Group 70–74, and 100% and 71.4% for Group ≥75. Patient survival at 1 and 5 years were respectively 92.9% and 68.0% for Group 65–69, 85.7% and 61.5% for Group 70–74 and 100% and 62.5% for Group ≥75. Serum creatinine did not significantly differ between the three groups, with the exception of serum creatinine at 1 year. Increased recipient age and prolonged time on dialysis correlated with increased occurrence of postoperative complication. An increase in BMI, pretransplant diabetes mellitus and prolonged time on dialysis correlated with the occurrence of delayed graft function (DGF). History of smoking was identified as an independent risk factor for events of rejection. Increased human leukocyte antigen mismatches (HLA-MM) and prolonged cold ischemia time (CIT) correlated with higher rates of intensive care unit (ICU) treatment. This study supports kidney transplantations for the very old. End-stage renal disease (ESRD) patients ≥75 years of age who underwent kidney transplantation experienced comparable results to their younger counterparts. A comprehensive evaluation of ESRD patients with consideration of prognostic risk factor is the most suitable mean of identifying adequate kidney transplant candidates.

scholarly journals Results of Deceased Donor Kidney Transplantation in Young Recipients after Age-matched and Mismatched (Old-to-young) Transplantation

2016 ◽  
Vol 16 (2) ◽  
pp. 8-11
Author(s):  
Janis Jushinskis ◽  
Vadims Suhorukovs ◽  
Aleksandrs Malcevs ◽  
Ieva Ziedina ◽  
Rafails Rozentals
Keyword(s):  
Graft Function ◽  
Deceased Donor ◽  
Rejection Rate ◽  
Donor Age ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Significant Difference ◽  
Deceased Donors ◽  
Kidney Transplantations

SummaryIntroduction.During the previous years the number of organ transplantations from elderly donors increased, and lack of young donors leads to necessity to allocate organs from elderly into young recipients.Aim of the Study.Was to analyse results of “old-to-young” allocation.Material and methods.This retrospective study analysed results of all consecutive deceased donor kidney transplantations (DDKT) performed in one transplant centre during the period from 01.01.2004 till 31.12.2007. Patients were selected based on availability of 5-year follow-up and age < 50 years (158 DDKT). Patients were divided into 2 groups according to donor age: age-mismatched group (donor age was > 55 years and at the same time > 15 years older than recipient; n=8, male/female=2/6, age 39,4 + 4,8 years, donor age 59,4 + 2,4 years), and age-matched group (n=150, male/female=88/62, age 36,0 + 11,0 years, donor age 37,3 + 12,0 years). Groups were compared for clinical and demographical features and posttransplant outcomes (delayed graft function, s-creatinin levels at discharge and after 5 years, acute rejection rate, graft and patient 5-year survival).Results.Comparison of demographical and clinical features revealed only relatively higher BMI in elderly donors (p=0.081) and higher frequency of age-mismatched allocation into female recipients (p=0.066). Early and late post-transplant outcomes showed no significant difference between groups, with similar 5-year graft and patient survival (p=NS for all compared factors).Conclusion.Results showed good kidney allograft function even in cases of age-mismatched allocation, which is significant opportunity in current situation with increasing age of deceased donors.

scholarly journals A nationwide evaluation of deceased donor kidney transplantation indicates detrimental consequences of early graft loss

2020 ◽  
Vol 97 (6) ◽  
pp. 1243-1252 ◽  
Author(s):  
Michèle J. de Kok ◽  
Alexander F. Schaapherder ◽  
Jacobus W. Mensink ◽  
Aiko P. de Vries ◽  
Marlies E. Reinders ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Loss ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Early Graft ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

P1776HLA TYPING BY NGS ENHANCES MISMATCH DETECTION IN LIVING KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sarah Pehnke ◽  
Tom H Lindner ◽  
Bernt Popp ◽  
Ilias Doxiadis ◽  
Ramona Landgraf ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Loss ◽  
Hla Typing ◽  
University Hospital ◽  
Kidney Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Typing Methods ◽  
Long Range Pcr ◽  
Hla Mismatches

Abstract Background and Aims Antibody mediated rejection (ABMR) due to the development of donor specific HLA antibodies is the most common cause for graft loss in kidney transplant recipients. Therefore, a low count of HLA mismatches is favorable in the course of transplantation. Hitherto, several techniques for HLA typing have been adapted in parallel, e.g. serological or low-resolution PCR. In this single-center study, we aimed to perform “HLA re-typing” by next generation sequencing (NGS) in a living kidney transplant cohort (n=143), in order to identify HLA mismatches in donor/recipient pairs, that were missed by previous HLA typing methods. Method We isolated DNA of 102 donor/recipient pairs, that received a living kidney transplantation at the University Hospital Leipzig (Germany) between 1998 and 2018, and performed long range PCR of all known HLA loci. Using these NGS results, we compiled a genomic HLA mismatch formula. We evaluated, if genomic HLA typing identifies more HLA mismatches compared to the results of previous HLA typing methods, that were recorded in the Eurotransplant database for our donor/recipient pairs. Results By genomic HLA typing, we were able to identify HLA mismatches in 10.2 % of donor/recipient pairs, that have been missed by previous methods. In our cohort, we recognized most mismatches in the DRB1 locus, that were missed with other HLA typing techniques. Conclusion Our results suggest, that genomic HLA typing can be more precise in detecting HLA mismatches in donor recipient/pairs. Especially in the course of living kidney transplantation, a higher accuracy in HLA typing might enhance donor selection. Furthermore, accurate HLA typing can influence graft management in the course of ABMR, as it may improve the detection of donor specific HLA directed antibodies.

scholarly journals Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Alfonso H. Santos ◽  
Michael J. Casey ◽  
Karl L. Womer
Keyword(s):  
Risk Factors ◽  
Graft Loss ◽  
Deceased Donor ◽  
The United States ◽  
Patient Death ◽  
Adult Kidney ◽  
Induction Regimen ◽  
Expanded Criteria ◽  
One Year ◽  
Hla Mismatches

We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0.35–0.91 and HR = 0.54, 95% CI = 0.27–1.08, resp.), while AR risk was lower with alemtuzumab in retransplant recipients with >3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44–0.93 and HR = 0.81, 95% CI = 0.63–1.06, resp.); (2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54, 95% CI = 0.34–0.86 and HR = 0.73, 95% CI = 0.51–1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% CI = 0.43–0.98 and HR = 0.82, 95% CI = 0.60–1.12, resp.). Therefore, specific risk factor-induction regimen combinations may predict outcomes and this information may help in individualizing induction in retransplant recipients.

scholarly journals Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20–50 years: a study by the ERA–EDTA Registry

2018 ◽  
Vol 35 (3) ◽  
pp. 534-543 ◽  
Author(s):  
Maria Pippias ◽  
Kitty J Jager ◽  
Anders Åsberg ◽  
Stefan P Berger ◽  
Patrik Finne ◽  
...  
Keyword(s):  
Graft Failure ◽  
Cox Regression ◽  
Deceased Donor ◽  
Survival Outcomes ◽  
Regression Methods ◽  
Risk Of Death ◽  
Deceased Donor Kidney ◽  
Deceased Donors ◽  
Kidney Transplantations

Abstract Background Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney. Methods We examined outcomes in 6448 European kidney allografts donated from younger (≥20–&lt;50 years) and older (≥50–&lt;70 years) deceased donors when transplanted into very young (≥20–&lt;35 years) or young (≥35–&lt;50 years) adult recipients. Outcomes of first kidney transplantations during 2000–13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods. Results The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1–24.9]} and young [15.3% (95% CI 13.7–16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9–41.5)] and young [29.2% (95% CI 25.1–33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44–0.68)] and 40% [young aHR 0.60 (95% CI 0.53–0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00–1.04)] or 1% [young aHR 1.01 (95% CI 1.00–1.01)] increase in the 10-year risk of death. Conclusions Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20–50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.

DONOR BIOPSY HISTOLOGY AND RESULTS OF 833 DECEASED DONOR KIDNEY TRANSPLANTATIONS

2008 ◽  
Vol 86 (Supplement) ◽  
pp. 190
Author(s):  
L Kyllönen ◽  
J Kahu ◽  
Ü Kirsimägi ◽  
K Salmela
Keyword(s):  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Kidney Transplantations ◽  
Donor Biopsy
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