Difference in Outcomes after Antibody Mediated Rejection between ABO-Incompatible and Positive Crossmatch Transplantations

Lionel Couzi, Miriam Manook, Ranmith Perera, Olivia Shaw, Zubir Ahmed, Nicos Kessaris, Anthony Dorling, Nizam Mamode

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    30 Citations (Scopus)

    Abstract

    Graft survival seems to be worse in positive crossmatch (HLAi) than in ABO-incompatible (ABOi) transplantation. However, it is not entirely clear why these differences exist. Sixty-nine ABOi, 27 HLAi, and 10 combined ABOi+HLAi patients were included in this retrospective study, in order to determine whether the frequency, severity, and the outcome of active antibody mediated rejection (AMR) were different. Five-year death-censored graft survival was better in ABOi than in HLAi and ABOi+HLAi patients (99%, 69%, and 64%, respectively, p=0.0002). Features of AMR were found in 38%, 95%, and 100% of ABOi, HLAi, and ABOi+HLAi patients that had a biopsy, respectively (p=0.0001 and p=0.001). After active AMR, a declining eGFR and graft loss were observed more frequently in HLAi and HLAi+ABOi than in ABOi patients. The poorer prognosis after AMR in HLAi and ABOi+HLAi transplantations was not explained by a higher severity of histological lesions or by a less aggressive treatment. In conclusion, ABOi transplantation offers better results than HLAi transplantation, partly because AMR occurs less frequently but also because outcome after AMR is distinctly better. HLAi and combined ABOi+HLAi transplantations appear to have the same outcome, suggesting there is no synergistic effect between anti-A/B and anti-HLA antibodies. This article is protected by copyright. All rights reserved.

    Original languageEnglish
    Number of pages26
    JournalTransplant International
    Early online date6 Jul 2015
    DOIs
    Publication statusPublished - 1 Oct 2015

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