title: Human leukocyte antigen antibody-incompatible renal transplantation: excellent medium-term outcomes with negative cytotoxic crossmatch.
abstract: BACKGROUND
  Human leukocyte antigen (HLA) antibody-incompatible renal transplantation has been increasingly performed since 2000 but with few data on the medium-term outcomes.
  
  
  METHODS
  Between 2003 and 2011, 84 patients received renal transplants with a pretreatment donor-specific antibody (DSA) level of more than 500 in a microbead assay. Seventeen patients had positive complement-dependent cytotoxic (CDC) crossmatch (XM), 44 had negative CDC XM and positive flow cytometric XM, and 23 had DSA detectable by microbead only. We also reviewed 28 patients with HLA antibodies but no DSA at transplant. DSAs were removed with plasmapheresis pretransplant, and patients did not routinely receive antithymocyte globulin posttransplant.
  
  
  RESULTS
  Mean follow-up posttransplantation was 39.6 (range 2-91) months. Patient survival after the first year was 93.8%. Death-censored graft survival at 1, 3, and 5 years was 97.5%, 94.2%, and 80.4%, respectively, in all DSA+ve patients, worse at 5 years in the CDC+ve than in the CDC-ve/DSA+ve group at 45.6% and 88.6%, respectively (P<0.03). Five-year graft survival in the DSA-ve group was 82.1%. Rejection occurred in 53.1% of DSA+ve patients in the first year compared with 22% in the DSA-ve patients (P<0.003).
  
  
  CONCLUSIONS
  HLA antibody-incompatible renal transplantation had a high success rate if the CDC XM was negative. Further work is required to predict which CDC+ve XM grafts will be successful and to treat slowly progressive graft damage because of DSA in the first few years after transplantation.
authors.affiliation: Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, West Midlands, United Kingdom. Robert.Higgins@uhcw.nhs.uk
authors.forename: Robert
authors.initials: R
authors.lastname: Higgins
authors.forename: David
authors.initials: D
authors.lastname: Lowe
authors.forename: Mark
authors.initials: M
authors.lastname: Hathaway
authors.forename: Clare
authors.initials: C
authors.lastname: Williams
authors.forename: For T
authors.initials: FT
authors.lastname: Lam
authors.forename: Habib
authors.initials: H
authors.lastname: Kashi
authors.forename: Lam Chin
authors.initials: LC
authors.lastname: Tan
authors.forename: Chris
authors.initials: C
authors.lastname: Imray
authors.forename: Simon
authors.initials: S
authors.lastname: Fletcher
authors.forename: Klaus
authors.initials: K
authors.lastname: Chen
authors.forename: Nithya
authors.initials: N
authors.lastname: Krishnan
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamer
authors.forename: Sunil
authors.initials: S
authors.lastname: Daga
authors.forename: Matthew
authors.initials: M
authors.lastname: Edey
authors.forename: Daniel
authors.initials: D
authors.lastname: Zehnder
authors.forename: David
authors.initials: D
authors.lastname: Briggs
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000628:therapy; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D014019:Tissue Donors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies