Abstract
Abstract Background and Aims In 2012, a kidney transplant (KT) exchange program for very-highly sensitized patients (panel reactive antibody [PRA] ≥95%) began in Andalusia between the 5 KT centers based on virtual crossmatch. Method Retrospective cohort study of KT recipients within the Andalusian very-highly sensitized patients’ program from 2012 to December 2021. Survival was analyzed using Kaplan-Meier. We performed a multivariable analysis using Cox regression for pre-KT risk factors for graft survival. Results During the study period, 213 KT were performed. The median PRA was 98%. of them, 18.7% were KT from type-III non-heart-beating donors and 69.5% were retransplanted patients. The median time on renal replacement therapy until KT was 1509 days and, from their inclusion in the very-highly sensitized patients’ program, 334 days. The median post-KT follow-up time was 1103 days. Patient/graft survival was 97.5%/91.7% and 82%/76.5% at one year and 5 years, respectively. Graft survival was lower in patients who had received more than one KT (P = .029). However, we found no differences when comparing PRA (< or ≥98%) or type of donor. In the multivariable analysis, the number of previous KT was a predictor of graft loss. We had more detailed information on renal function and post-KT complications in patients from 3 centers (n=104). Six patients (5.7%) developed donor-specific antibodies (DSA) (1 class I, 3 class II, 2 class I and II) after a median of 267.5 days post-KT. Ten patients (9.3%) presented acute rejection (AR) diagnosed by biopsy: 4 T-cell-mediated rejection (3.7%) and 6 antibody-mediated rejection (5.6%). Active antibody-mediated chronic rejection (CR) was diagnosed in 5 patients and BK nephropathy in 2. Three graft losses were due to immunological causes (1 RA, 2 RC). Median renal function at one year was: Crp 1.3 mg/dl and glomerular filtration rate 55.1 ml/min. Conclusion Despite being a high-risk group, the survival results have been very satisfactory. The number of previous KT is a risk factor for graft survival.
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