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Cadaveric renal transplant in the highly sensitized African-American patient
J Abrams1, S Smolinski, H Nathan
1Delaware Valley Transplant Program, Philadelphia, Pennsylvania 19103.
Insights
Early graft failure in abdominal aortic aneurysm (AA) transplants, unlike cadaveric aortic (CAUC) transplants, suggests factors beyond traditional variables. Further investigation into HLA antibody specificity is recommended for highly sensitized recipients.
Area of Science:
- Nephrology
- Transplantation Immunology
- Organ Transplantation
Background:
- Cadaveric aortic (CAUC) and abdominal aortic (AA) transplants are common procedures in renal transplantation.
- Graft survival rates can be influenced by various donor and recipient factors, including ischemia time, HLA mismatch, and prior sensitization.
- Understanding early graft failure is crucial for improving long-term transplant outcomes, especially in challenging recipient populations.
Purpose of the Study:
- To investigate the statistically significant difference in 1-year graft survival between CAUC and AA renal transplants.
- To identify potential factors contributing to early graft failures observed in AA transplants.
- To provide recommendations for improving transplant outcomes in highly sensitized recipients.
Main Methods:
- Comparative analysis of 1-year graft survival between CAUC and AA renal transplant groups.
- Multivariate analysis to assess the distribution of traditional variables (CIT, HLA mismatch, transplant number, PRA) in both groups.
- Review of early post-transplant failure events and consideration of factors like immunosuppression and donor-specific antibodies.
Main Results:
- A statistically significant difference in 1-year graft survival was observed between CAUC and AA transplants.
- Nine AA transplants failed within the first week post-transplant, contributing to the observed survival difference.
- Traditional variables (CIT, HLA mismatch, transplant number, PRA) did not explain the difference in graft survival between the groups.
Conclusions:
- Early graft failure in AA transplants suggests factors beyond standard criteria are involved.
- HLA antibody specificity and potential sensitization to donor antigens warrant further investigation.
- Consideration of more sensitive crossmatch techniques, like flow cytometry, is recommended for highly sensitized recipients.
Abstract:
A statistically significant difference was discovered when comparing the 1-year graft survival of CAUC and AA. The difference was due in part to nine AA failures that occurred within the first week posttransplant (Fig 3). Using a multivariant analysis both the AA and CAUC were found to be normally distributed in regard to CIT, HLA mismatch, transplant number, and PRA. If these traditional variables thought to have relevance on graft survival in cadaveric renal transplantation are ruled out as contributing factors other avenues must be explored. If credence is given to the theory that the difference in function between AA and CAUC is due to the difference in the number of transplants that failed within the first week then factors such as immunosuppressive therapy and noncompliance can also be ruled out. One possible area of explanation may lie in the area of specificity to HLA antibody. It is possible that these recipients received transplants from a donor to which they were sensitized. A closer analysis of donor and recipient HLA typing as well as the recipient's transfusion and transplant history is recommended. Despite the fact that all transplants occurred in the presence of negative preliminary and final XM's using American Society for Histocompatibility and Immunogenetics (ASHI) certified techniques (Table 2), transplant centers may wish to consider using a more sensitive XM technique such as flow cytometry for these patients. We hope that these recommendations will enable transplant centers to continue their commitment to transplanting the highly sensitized recipient.