title: Positive cross-match living donor kidney transplantation: longer-term outcomes.
abstract: The long-term graft outcomes after positive cross-match (PXM) living donor kidney transplantation (LDKT) are unknown and the descriptive published data present short-medium term results. We conducted a retrospective cohort study of LDKT with PXM by flow cytometry performed at our center during February 1999 to October 2006, compared to a control group, matched 1:1 for age, sex, race, retransplantation and transplant year. The PXM group was treated with a course of plasmapheresis/low-dose intravenous immunoglobulin (IVIg) preoperatively, and OKT3 or thymoglobulin induction. Both groups (n = 41 each) were comparable except for duration of end-stage renal disease (ESRD), induction, HLA mismatch and panel-reactive antibody (PRA). During the period of up to 9 years, 14 PXM and 7 controls lost their grafts (p < 0.04). Graft survival rates at 1 and 5 years were 89.9% and 69.4% for PXM group and 97.6% and 80.6% for the controls, respectively. PXM was associated with higher risk of graft loss (HR 2.6, p = 0.04; 95%CI 1.03-6.4) (t(1/2)= 6.8 years), but not with patient survival (HR 1.96, p = 0.29; 95%CI 0.6-7.0) or 1-year serum creatinine (beta= 0.06, p = 0.59 for ln (SCr); 95% CI -0.16 to 0.28). These results suggest that despite the favorable short-term results of PXM LDKT after PP/IVIg conditioning, medium-long-term outcomes are notably worse than expected, perhaps comparable to non-ECD deceased donor kidney transplantation (KT).
authors.affiliation: Department of Medicine, University of MAryland School of Medicine, Baltimore, MD, USA. ahariria@medicine.umaryland.edu
authors.forename: A
authors.initials: A
authors.lastname: Haririan
authors.forename: J
authors.initials: J
authors.lastname: Nogueira
authors.forename: D
authors.initials: D
authors.lastname: Kukuruga
authors.forename: E
authors.initials: E
authors.lastname: Schweitzer
authors.forename: J
authors.initials: J
authors.lastname: Hess
authors.forename: C
authors.initials: C
authors.lastname: Gurk-Turner
authors.forename: S
authors.initials: S
authors.lastname: Jacobs
authors.forename: C
authors.initials: C
authors.lastname: Drachenberg
authors.forename: S
authors.initials: S
authors.lastname: Bartlett
authors.forename: M
authors.initials: M
authors.lastname: Cooper
mesh_terms: D000328:Adult; D003401:Creatine / Q000097:blood; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006649:Histocompatibility Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006649:Histocompatibility Antigens; D003401:Creatine