Positive crossmatch kidney transplant recipients treated with eculizumab: outcomes beyond 1 year.
This study examined outcomes beyond 1 year in eculizumab-treated (EC) positive crossmatch kidney transplants (+XMKTx) compared to a historical control group. +XMKTx received desensitization with either plasma exchange (PE) alone (N = 48) or PE and EC (N = 30). EC, given for at least 1 month, was continued in the setting of persistently high DSA (B flow cytometric crossmatch [BFXM] >200) including: 4 weeks (n = 14); 9 weeks (n = 6), 6 months (n = 2), and 12 months (n = 8). All patients had at least 2 years follow-up. The incidence of acute clinical ABMR was lower in the EC group than controls (6.7% vs. 43.8% p < 0.01). Death-censored allograft survival was similar between groups. Chronic ABMR was the main cause of graft loss. On 1-year protocol biopsies, no differences were noted between EC and controls including: cg score >0, 26.7% versus 31.9% (p = 0.62), ptc score ≥ 2, 60.0% versus 60.0% (p = 1.00), or C4d + , 33.8% versus 13.5% (p = 0.08). A persistently high BFXM in EC-treated patients was associated with cg score >0 at 1 year, while EC appeared to protect against cg if the BFXM remained low. We conclude that despite decreasing acute clinical ABMR rates, EC treatment does not prevent chronic ABMR in recipients with persistently high BFXM after +XMKTx.
Division of Anatomic Pathology, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN.
L D
LD
Cornell
C A
CA
Schinstock
M J
MJ
Gandhi
W K
WK
Kremers
M D
MD
Stegall
D000328:Adult; D000906:Antibodies / Q000737:chemistry; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001706:Biopsy; D015331:Cohort Studies; D003165:Complement System Proteins / Q000737:chemistry; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D051437:Renal Insufficiency / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D000906:Antibodies; D061067:Antibodies, Monoclonal, Humanized; D003165:Complement System Proteins; C481642:eculizumab
Alloantibody; antibody-mediated (ABMR); chronic; crossmatch; fusion proteins; immunosuppressant; monoclonal antibodies