In:
Clinical Transplantation, Wiley, Vol. 31, No. 10 ( 2017-10)
Abstract:
The effectiveness of desensitization with rituximab in ABO ‐incompatible renal transplantation ( ABO ‐I) has been widely reported. However, ABO ‐I outcomes are still worse than those of ABO ‐identical or ABO ‐compatible renal transplantation ( ABO ‐Id/C). We retrospectively examined the outcomes in consecutive living donor ABO ‐Id/C (n = 412) and ABO ‐I (n = 205) cases to elucidate the causes of inferiority in ABO ‐I. ABO ‐I cases included recipients treated with rituximab ( RIT , n = 131), splenectomy ( SPX , n = 21), or neither because of low anti‐A/B antibody titers (NoR/S, n = 53). Graft survival, infection, and de novo HLA antibody production were compared for ABO ‐I and ABO ‐Id/C, followed by stratification into RIT and NoR/S groups. Propensity score‐based methods were employed to limit selection bias and potential confounders. Overall graft survival for ABO ‐I was significantly lower than that for ABO ‐Id/C (92.8% vs 97.2% after 5 years, P = .0037). Graft loss due to infection with ABO ‐I was significantly more frequent than that with ABO ‐Id/C, whereas acute antibody‐mediated rejection ( AMR ) caused no graft failure in ABO ‐I recipients. Stratified analysis demonstrated significantly higher infection risk with RIT than with NoR/S. Safe reduction or avoidance of rituximab in desensitization protocols might contribute to further improvement of ABO ‐I outcome.
Type of Medium:
Online Resource
ISSN:
0902-0063
,
1399-0012
DOI:
10.1111/ctr.2017.31.issue-10
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2739458-X
detail.hit.zdb_id:
2004801-4
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