Renal transplantation across the donor-specific antibody barrier: Graft outcome and cancer risk after desensitization therapy
Journal
Journal of the Formosan Medical Association
Journal Volume
115
Journal Issue
6
Pages
426-433
Date Issued
2016
Abstract
Background/Purpose: Desensitization regimens including use of intravenous immune globulin and rituximab have been reported to overcome renal transplant hyperacute rejection. A retrospective case-control study was performed to assess the results and complications of renal transplantation with desensitization therapy for donor-specific antibody (DSA) in a transplant center in Asia, where donor exchange was usually not allowed. Methods: Between January 2007 and December 2013, 22 patients with DSA received live-donor renal transplantation after desensitization (DSA group). During the same period, the DSA group was compared to the NSA group (152 renal transplants) who had no specific antibody to the donors (66 from deceased donors and 86 from living relatives). Rejection, renal function, graft and patient survival rates, infection, and cancer incidence were reviewed and analyzed from medical records. Results: The DSA group (46.8%) had significantly higher acute rejection rates than the NSA group (13.7%) at the 1-year follow-up. The estimated renal function, 5-year graft, and patient survival rates were comparable between the groups. The DSA group (19.6%) had significantly higher 5-year de novo cancer incidence than the NSA group (8.5%; p = 0.028); three patients of the DSA group developed urothelial carcinoma 17.0 ± 3.0 months after transplantation. By using stepwise Cox regression analysis, desensitization therapy was identified as the sole independent risk factor for post-transplant urothelial carcinoma. Conclusion: When compared to renal transplantation without DSA, desensitization therapy for DSA resulted in equivalent renal transplant outcome but potentially increased risk of urothelial carcinoma after transplantation. ? 2015.
SDGs
Other Subjects
antibody; donor specific antibody; immunoglobulin; methylprednisolone; mycophenolate mofetil; rituximab; tacrolimus; unclassified drug; alloantibody; HLA antigen; acute graft rejection; Article; cancer incidence; cancer risk; case control study; desensitization; graft survival; human; immunosuppressive treatment; infection; infection prevention; kidney donor; kidney function; kidney graft rejection; kidney transplantation; major clinical study; outcome assessment; plasmapheresis; retrospective study; risk factor; survival rate; transitional cell carcinoma; adult; adverse effects; carcinoma; desensitization; donor; female; graft rejection; immunology; kidney transplantation; male; middle aged; mortality; pathology; survival analysis; Taiwan; Urologic Neoplasms; urothelium; Adult; Carcinoma; Case-Control Studies; Desensitization, Immunologic; Female; Graft Rejection; HLA Antigens; Humans; Isoantibodies; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Analysis; Taiwan; Tissue Donors; Urologic Neoplasms; Urothelium
Publisher
Elsevier B.V.
Type
journal article