title: Kidney transplantation: evaluation and clinical outcome of 237 recipients at low, medium, high, or strong immunological risk of rejection.
abstract: BACKGROUND
  Donor-specific antibodies (DSAs) play a fundamental role in kidney transplantation. The identification of DSAs is an essential rejection parameter.
  
  
  METHODS
  We evaluated a protocol in 237 patients receiving kidneys from living (LDs) and deceased donors (DDs). Recipients were classified as being at low (LR), medium (MR), high (HR), or strong (SR) risk of rejection based on Luminex panel reactive antibody (PRA)-single antigen beads (SABs). Grafts that survived for 1 year were evaluated.
  
  
  RESULTS
  Of the 237 transplanted patients, 129 (54.43%) received a kidney from an LD and 108 (45.57%) from a DD. Of 95 LR recipients receiving kidneys from LDs, 2 patients lost the graft due to non-immunological causes. Of 34 MR recipients, 13 had rejection episodes, and 2 lost the graft by AMR and one by cellular rejection (CR). Of 108 recipients receiving a kidney from a DD, 59 (54.63%) were LR, 31 (28.70%) MR, 11 (10.19%) HR, and 7 (6.48%) SR. Twenty of all transplanted recipients lost their grafts; 4 were due to clinical causes, 4 by cellular rejection, and 12 by antibody-mediated rejection (AMR) with PRA-SAB mean fluorescent intensity of 530 to 12,591. One-year graft survival for LD transplanted LR and MR patients was 97.6% and 94.1%, respectively (P = .004). In DD recipients, the LR vs MR SD was P = .011, and for LR vs HR + SR it was P = .001. For MR vs HR+SR no SD was found (P = .323).
  
  
  CONCLUSIONS
  Rejections were detected in 51 patients (21.52%). Graft failure occurred in 16 patients (6.75%). A total of 218 (91.98%) recipients maintained good kidney function after 1 year. This protocol based on fluxogram risk assessment of AMR provided fast and precise immunological evaluation of recipients and donors and stratification by immunological risk of AMR.
authors: Instituto de Ensino e Pesquisas, Clínica de Transplantes do Hospital Santa Casa de Belo Horizonte, MG, Brasil; IMUNOLABTx-Laboratório de Histocompatibilidade, B. Horizonte, MG, Brasil; Grupo de Transplante renal, Hospital de Clínicas da UFMG, Belo Horizonte, MG, Brasil. Electronic address: evaldo@imunolabtx.com.br.
authors: E
authors: E
authors: Nascimento
authors: Universidade Federal de Minas Gerais (UFMG), ICEx/ICB Bioinformática, Belo Horizonte, MG, Brasil; IMUNOLABTx-Laboratório de Histocompatibilidade, B. Horizonte, MG, Brasil.
authors: R A
authors: RA
authors: Fabreti de Oliveira
authors: Grupo de Transplante renal, Hospital de Clínicas da UFMG, Belo Horizonte, MG, Brasil.
authors: M D
authors: MD
authors: Maciel
authors: Instituto de Ensino e Pesquisas, Clínica de Transplantes do Hospital Santa Casa de Belo Horizonte, MG, Brasil.
authors: A B
authors: AB
authors: Pereira
authors: Grupo de Transplante renal, Hospital de Clínicas da UFMG, Belo Horizonte, MG, Brasil.
authors: F
authors: F
authors: das Mercêz de Lucas
authors: Grupo de Transplante renal, Hospital de Clínicas da UFMG, Belo Horizonte, MG, Brasil.
authors: A
authors: A
authors: Salomão-Filho
authors: Instituto de Ensino e Pesquisas, Clínica de Transplantes do Hospital Santa Casa de Belo Horizonte, MG, Brasil.
authors: W A
authors: WA
authors: Pereira
authors: Hospital Felício Rocho, Grupo de Transplantes, B. Horizonte, MG, Brasil.
authors: J B
authors: JB
authors: Moreira
authors: Hospital Felício Rocho, Grupo de Transplantes, B. Horizonte, MG, Brasil.
authors: S S
authors: SS
authors: Vilaça
authors: Hospital Felício Rocho, Grupo de Transplantes, B. Horizonte, MG, Brasil.
authors: R
authors: R
authors: de Castro Gontijo
authors: Hospital Universitário São José, Belo Horizonte, MG, Brasil.
authors: M F
authors: MF
authors: Lasmar
authors: Hospital Universitário São José, Belo Horizonte, MG, Brasil.
authors: H R
authors: HR
authors: Vianna
authors: Hospital Evangelico, Belo Horizonte, MG, Brasil.
authors: A
authors: A
authors: Magalhâes
authors: Hospital Márcio Cunha, Ipatinga, MG, Brasil.
authors: C A C
authors: CA
authors: Calazans
authors: MG-Transplantes/CNCDO, FHEMIG, B. Horizonte, MG, Brasil.
authors: C
authors: C
authors: Simão-Filho
authors: IMUNOLABTx-Laboratório de Histocompatibilidade, B. Horizonte, MG, Brasil.
authors: B
authors: B
authors: Vilela
mesh_terms: D000328:Adult; D000906:Antibodies / Q000737:chemistry; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006680:HLA Antigens / Q000737:chemistry; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D003404:Creatinine