Abstract
BackgroundKidney allograft survival continuously improved with introduction of novel immunosuppressants. However, also immunologically challenging transplants (blood group incompatibility and sensitized recipients) increase. Between 2006 and 2008, a new tailored immunosuppression scheme for kidney transplantation was implemented at the University Hospital in Zurich, together with an ABO-incompatible transplant program and systematic pre- and posttransplant anti-human leukocyte antigen (HLA) antibody screening by Luminex technology. This study retrospectively evaluated the results of this tailored immunosuppression approach with a particular focus on immunologically higher risk transplants.MethodsA total of 204 consecutive kidney transplantations were analyzed, of whom 14 were ABO-incompatible and 35 recipients were donor-specific anti-HLA antibodies (DSA) positive, but complement-dependent cytotoxicity crossmatch (CDC-XM) negative. We analyzed patient and graft survival, acute rejection rates and infectious complications in ABO-compatible versus -incompatible and in DSA positive versus negative patients and compared those with a historical control group.ResultsOverall patient, death-censored allograft survival and non-death-censored allograft survival at 4 years were 92, 91 and 87%, respectively. We found that (1) there were no differences between ABO-compatible and -incompatible and between DSA positive and DSA negative patients concerning acute rejection rate and graft survival; (2) compared with the historical control group there was a significant decrease of acute rejection rates in sensitized patients who received an induction with thymoglobulin; (3) there was no increased rate of infection among the patients who received induction with thymoglobulin compared to no induction therapy.ConclusionsWe observed excellent overall mid-term patient and graft survival rates with our tailored immunosuppression approach. Induction with thymoglobulin was efficient and safe in keeping rejection rates low in DSA positive patients with a negative CDC-XM.
Highlights
Kidney allograft survival continuously improved with introduction of novel immunosuppressants
Allograft survival after kidney transplantation has substantially improved with modern immunosuppressive drugs - in the first year post-transplant, but still 5–10% of patients suffer from acute rejection, which overall leads to a reduced graft survival [1,2,3]
Previous studies showed that induction with thymoglobulin leads to a reduction of acute rejections in donor-specific antiHLA antibodies (DSA) positive, complement-dependent cytotoxicity crossmatch (CDC-XM) negative patients [13,14,15]
Summary
Kidney allograft survival continuously improved with introduction of novel immunosuppressants. To avoid immunologically incompatible transplantation (AB0 incompatibility, DSA positive patients) paired kidney donation was introduced in many countries including Switzerland, a procedure allowing conversion of incompatible to compatible pairs [10]. If this is not possible risk-adapted immunosuppression and/or desensitization represent alternative options [11]. Previous studies showed that induction with thymoglobulin leads to a reduction of acute rejections in DSA positive, complement-dependent cytotoxicity crossmatch (CDC-XM) negative patients [13,14,15]
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