Comparison of kidney transplant outcomes in HLA compatible and incompatible transplantation: a national cohort study

Rennie, T. J. W. et al. (2022) Comparison of kidney transplant outcomes in HLA compatible and incompatible transplantation: a national cohort study. Nephrology, 27(12), pp. 962-972. (doi: 10.1111/nep.14102) (PMID:36028988)

Abstract

Background: Reports of HLA incompatible (HLAi) kidney transplant outcomes are inconclusive, especially in the context of lower level Donor Specific Antibodies (DSA). Methods: Multi-centre national cohort study of HLAi kidney transplant recipients matched in 1:2 ratio with HLA compatible (HLAc) kidney transplant recipients. HLAi defined as DSA identified by Luminex. Antibody mediated rejection (AMR) and transplant-survival were analysed using Kaplan-Meier plots. Propensity score (PS) matching was used to compare recipient and transplant survival between groups. Results: We included 61 HLAi and 122 HLAc recipients; mean age 46 years; 60% female. MFIT0: 3327 (IQR 1352 – 6458), 23 (38%) were Flow cytometry crossmatch positive (FC-XMPOS). DSAPOS/FC-XMPOS transplantation carried an increased risk of AMR at 1 year (52%) compared to DSAPOS/FC-XMNEG (27%) and HLAc (0%). Unadjusted death censored graft loss at 3 years was 13% (HLAi) and 8% (HLAc). Three-year patient survival was 95% in HLAc, 84% in DSAPOS/FC-XMNEG and 69% in DSAPOS/FC-XMPOS recipients; 58% of HLAi deaths were infection-related. HLA incompatibility was associated with a decreased 3-year survival in our PS-matched cohort. Conclusion: In kidney transplantation, DSA and positive FC-XM carries an increased risk of AMR. Despite inferior transplant and survival outcomes compared to HLAc transplantation, it remains a realistic option for highly sensitised patients facing prolonged waiting times and reduced survival on dialysis.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Geddes, Dr Colin and Little, Dr Ann-Margaret and Padmanabhan, Dr Neal and Clancy, Mr Marc
• Authors: Rennie, T. J. W., Battle, R. K., Abel, A. A., McConnell, S., McLaren, R., Phelan, P. J., Geddes, C., Padmanabhan, N., Clancy, M. J., Little, A.-M., and Turner, D. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Nephrology
• Publisher: Wiley
• ISSN: 1320-5358
• ISSN (Online): 1440-1797
• Published Online: 26 August 2022
• Copyright Holders: Copyright © 2022 Asian Pacific Society of Nephrology
• First Published: First published in Nephrology 27(12): 962-972
• Publisher Policy: Reproduced in accordance with the publisher copyright policy