title: Living-donor kidney transplantation with existing anti-donor specific antibodies at a Japanese single center.
abstract: Improving the short-term outcome of kidney transplantation, the rejection induced by anti-donor specific antibody (DSA) has been the large complication. We analyzed 324 living-donor kidney transplant recipients (procedures performed between April 2003 and August 2014) to investigate the outcome of kidney transplant recipients with DSA. We divided them into four groups (anti-blood type antibody alone, group A [n = 73]; anti-human lymphocyte antigen [HLA] antibody alone, group B [n = 11]; both antibodies, group C [n = 8]; and no DSA, group D [n = 232]) and investigated the incidence of rejection and those histologic findings. Each case with DSA underwent some desensitization therapy before transplantation. There was no significant difference in graft survival (all cases: 100% at 1 year, group A: 97.6%, B: 95.9%, C: 100%, and at 5 years, group D: 96.1%). There were some significant differences in incidence of acute antibody-mediated rejection (AAMR) and chronic active antibody-mediated rejection (CAAMR) among four groups (group A: 4.1% and 2.7%, B: 18.2% and 9.1%, C: 12.5% and 12.5%, D: 0% and 0.9%, respectively). Each AAMR case was improved by ordinary desensitization therapy, but half of the CAAMR cases, diagnosed early after transplantation, had no effect of any therapy to result in graft failure. Our results suggested that even the case with DSA could be transplanted safely by some desensitization therapy. However, we should be cautious regarding recipients with DSA for the long term even if there is no histologic change early after transplantation because graft loss may occur due to CAAMR.
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan. Electronic address: ushi@koto.kpu-m.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Ushigome
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Harada
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Nakao
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Koshino
authors.affiliation: Department of Organ Interaction Research Medicine, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Nobori
authors.affiliation: Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Japan; Department of Organ Interaction Research Medicine, Kyoto Prefectural University of Medicine, Kyoto City, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007564:Japan; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000906:Antibodies