Transplant outcomes in positive complement-dependent cytotoxicity- versus flow cytometry-crossmatch kidney transplant recipients after successful desensitization: a retrospective study

摘要

BACKGROUND:Despite the obvious survival benefit compared to that among waitlist patients, outcomes of positive crossmatch kidney transplantation (KT) are generally inferior to those of human leukocyte antigen (HLA)-compatible KT. This study aimed to compare the outcomes of positive complement-dependent cytotoxicity (CDC) crossmatch (CDC?+?FC+) and positive flow cytometric crossmatch (CDC-FC+) with those of HLA-compatible KT (CDC-FC-) after successful desensitization.METHODS:We retrospectively analyzed 330 eligible patients who underwent KTs between June 2011 and August 2017: CDC-FC- (n?=?274), CDC-FC+ (n?=?39), and CDC?+?FC+ (n?=?17). Desensitization protocol targeting donor-specific antibody (DSA) involved plasmapheresis, intravenous immunoglobulin (IVIG), and rituximab with/without bortezomib for positive-crossmatch KT.RESULTS:Death-censored graft survival and patient survival were not different among the three groups. The median estimated glomerular filtration rate was significantly lower in the CDC?+?FC+ group than in the compatible group at 6?months (P??0.001) and 2?years (P?=?0.020). Biopsy-proven rejection within 1?year of CDC-FC-, CDC-FC+, and CDC?+?FC+ were 15.3, 28.2, and 47.0%, respectively. Urinary tract infections (P??0.001), Pneumocystis jirovecii pneumonia (P??0.001), and cytomegalovirus viremia (P??0.001) were more frequent in CDC-FC+ and CDC?+?FC+ than in CDC-FC-.CONCLUSIONS:This study showed that similar graft and patient survival was achieved in CDC-FC+ and CDC?+?FC+ KT compared with CDC-FC- through DSA-targeted desensitization despite the higher incidence of rejection and infection than that in compatible KT.