title: Outcomes of living donor renal transplants with a negative cross-match and pretransplant donor-specific antibody.
abstract: BACKGROUND
  Management of renal transplant recipients with a negative complement-dependent cytotoxicity-antihuman globulin (CDC-AHG) cross-match and pretransplant donor-specific antibody (DSA) is controversial. We sought to compare outcomes of immunologically high-risk living donor (LD) renal transplant recipients with and without DSA.
  
  
  METHODS
  We conducted a single-center, retrospective review of all high immune-risk LD renal transplant recipients with a negative CDC-AHG cross-match performed between January 2008 and December 2010. Pretransplant desensitization for DSA was not utilized. Immunosuppression consisted of thymoglobulin induction, followed by tacrolimus, myeophenolate mofetil, and prednisone. DSA was assessed pretransplant and at 1, 3, 6, 9, and 12 months, and every 6 months thereafter.
  
  
  RESULTS
  Between January 2008 and December 2010, 44 LD renal transplants were performed in high immune-risk recipients with a negative CDC-AHG cross-match. Outcomes of 14 recipients with pretransplant DSA were compared with 30 recipients with no DSA. After a median follow-up of 26 months (range, 12-40), overall death-censored graft survival was 100%, with no acute rejection episodes in the DSA group and 1 antibody-mediated rejection in the non-DSA cohort. Mean serum creatinines of the DSA and non-DSA groups at 1 year post-transplant were 1.0 ± 0.4 and 1.2 ± 0.6 mg/dL (P = NS), respectively. Among the pretransplant DSA cohort, 5 of the 14 (36%) developed persistent post-transplant DSA at a median of 9 months (range, 3-24) versus 2 of 30 (7%; P = .025) at a median of 12 months post-transplant in the non-DSA cohort. All recipients in the pretransplant DSA group underwent renal biopsy for persistent post-transplant DSA. Three of 5 biopsies showed C4D deposition in peritubular capillaries without glomerulopathy or arteriopathy.
  
  
  CONCLUSIONS
  Early post-transplant outcomes for LD recipients with a negative cross-match and pretransplant DSA were excellent. In recipients with good and stable renal function, the significance of persistent post-transplant DSA in combination with C4D deposition on biopsy is unclear at this time.
authors.affiliation: Department of Surgery, The Methodist Hospital, Houston, Texas, USA. rjknight@tmhs.org
authors.forename: R J
authors.initials: RJ
authors.lastname: Knight
authors.forename: J M
authors.initials: JM
authors.lastname: Devos
authors.forename: S J
authors.initials: SJ
authors.lastname: Patel
authors.forename: G
authors.initials: G
authors.lastname: Land
authors.forename: L W
authors.initials: LW
authors.lastname: Moore
authors.forename: L
authors.initials: L
authors.lastname: Gaber
authors.forename: A O
authors.initials: AO
authors.lastname: Gaber
mesh_terms: D000328:Adult; D000906:Antibodies / Q000008:administration & dosage*; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000906:Antibodies