title: Difference in outcomes after antibody-mediated rejection between abo-incompatible and positive cross-match transplantations.
abstract: Graft survival seems to be worse in positive cross-match (HLAi) than in ABO-incompatible (ABOi) transplantation. However, it is not entirely clear why these differences exist. Sixty-nine ABOi, 27 HLAi and 10 combined ABOi+HLAi patients were included in this retrospective study, to determine whether the frequency, severity and the outcome of active antibody-mediated rejection (AMR) were different. Five-year death-censored graft survival was better in ABOi than in HLAi and ABOi+HLAi patients (99%, 69% and 64%, respectively, P = 0.0002). Features of AMR were found in 38%, 95% and 100% of ABOi, HLAi and ABOi+HLAi patients that had a biopsy, respectively (P = 0.0001 and P = 0.001). After active AMR, a declining eGFR and graft loss were observed more frequently in HLAi and HLAi+ABOi than in ABOi patients. The poorer prognosis after AMR in HLAi and ABOi+HLAi transplantations was not explained by a higher severity of histological lesions or by a less aggressive treatment. In conclusion, ABOi transplantation offers better results than HLAi transplantation, partly because AMR occurs less frequently but also because outcome after AMR is distinctly better. HLAi and combined ABOi+HLAi transplantations appear to have the same outcome, suggesting there is no synergistic effect between anti-A/B and anti-HLA antibodies.
authors.affiliation: Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Lionel
authors.initials: L
authors.lastname: Couzi
authors.affiliation: Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.|Medical Research Council Centre for Transplantation, King's College London, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Manook
authors.affiliation: Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Ranmith
authors.initials: R
authors.lastname: Perera
authors.affiliation: Clinical Transplant Laboratory, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Olivia
authors.initials: O
authors.lastname: Shaw
authors.affiliation: Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.|Medical Research Council Centre for Transplantation, King's College London, London, UK.
authors.forename: Zubir
authors.initials: Z
authors.lastname: Ahmed
authors.affiliation: Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Nicos
authors.initials: N
authors.lastname: Kessaris
authors.affiliation: Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.|Medical Research Council Centre for Transplantation, King's College London, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dorling
authors.affiliation: Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.|Medical Research Council Centre for Transplantation, King's College London, London, UK.
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology*; D001788:Blood Grouping and Crossmatching; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000628:therapy; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000401:mortality; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies
keywords: ABO-incompatible; antibody-mediated rejection; donor-specific antibodies; kidney transplantation; positive cross-match