SAT-352 THE EFFECT OF IMMUNOLOGICAL RISK ASSESSMENT ON GRAFT AND PATIENT SURVIVAL BEFORE KIDNEY TRANSPLANTATION

Abstract

Kidney transplantation is the most successful renal replacement therapy for patients with end stage renal disease (ESRD), which offers improving quality of life and survival advantage. In our center, since 1970 complement-dependent cytotoxicity cross match, since 2002 standard panel reactive antibody screening (PRA-class I and II) and since December 2015 flow cytometry crossmatch (FCM-XM) assay and detection of anti-HLA antibodies with more specific methods and measuring mean fluorescence intensity (MFI) titers have been performed pretransplant cadaver and living kidney recipients. The aim of this study was to evaluate the immunological/non-immunological complications, graft and patients survivals and the factors affecting survival in kidney transplant recipients who underwent transplantation between January 1993 and March 2018. 630 patients who underwent kidney transplantation were enrolled. Group I include 148 patients who were just tested with CDC-XM, group II include 96 patients who were tested with CDC XM and PRA screening and group III include 96 patients who were tested with FCM-XM and detailed PRA. Patients’ demographic features, laboratory and transplantation data were compared. Graft and patient survival and factors affecting them were analyzed. Also after determining the differences of these groups patients were matched based on the propensity score match analysis after that analyzes were repeated. Comprasion of patient and transplantation characteristics is shown at Table 1. The mean follow-up period was 113±85 months in group I, 92±45 months in group II, and 25±8 months in group III (p<0.001). The rate of cadaveric donor were similar in each group. The mean number of HLA mismatches was 2±1 in group I, 3±2 in group II, and 3±1 in group III (p<0,001). It has been observed that the number of PRA positive recipients increased in recent periods with known PRA status (p=0,001). The rate of given induction treatment and maintenance immunosuppressive treatment regimens also changed over time. While the average creatinine and glomerular filtration rate (GFR) at discharge was similar in groups (p=0.852), GFR was lower in group I than the other two groups during the follow-up (p<0.001). Acute rejection rate was highest in group I and least in group II (p<0.001). Graft survival was higher in the other period than in the tested only with CDC-XM period (group I) (p=0.019) and patient survival was also higher in group II and III in each years during follow-up (p<0,05). After matching the age, sex, donor type and HLA mismatch number of the patients with propensity score, 48 patients in group I, 55 patients in group II and 51 patients in group III were matched and the analyzes were repeated. After analysis, graft and patient survival were higher in group II and III than in group I. With improvements in immunological risk assessment, the use of related tests before renal transplantation and since 2000s the development of immunosuppressive theraphy have positively affected graft and patient survival in kidney transplant patients in our center, although transplantations were made to higher-risk patients recent years. Detailed assessment of immunological risk and individualization of pretransplant evaulation and induction and maintenance therapies may also have played a role in improving graft and patient survival.