Use of cryopreserved cadaveric vein allograft for hemodialysis access precludes kidney transplantation because of allosensitization.

ABSTRACT

BACKGROUND: Dimethyl sulfoxide-cryopreserved cadaveric vein allografts have recently been proposed as an alternative to prosthetic grafts in the problem hemodialysis population. The transfer of mismatched major histocompatibility complex I and II molecules in association with these allografts can potentially lead to allosensitization in nonimmunosuppressed individuals. METHODS: In a university-affiliated medical center, 20 consecutive patients receiving technically successful upper arm cadaveric vein allograft fistulas (CAVFs) for hemodialysis between April 1999 and April 2000 were studied. A control cohort of 20 patients on a kidney transplantation waiting list was selected by nurses blinded to the study. These patients were matched for age, sex, history of transfusion, pregnancy, cause of kidney failure, and prior transplantation. The panel reactive antibody (PRA) values were recorded in this group over the same time period as the CAVF group. RESULTS: Patients receiving CAVFs had a mean PRA assay value of 84.1% (median, 96.5%) at an average of 3.1 months after engraftment (median, 1.5 months). The preengraftment PRA values were available for seven patients who were on the transplant waiting list. Six of these patients had nonreactive PRA assays before CAVF creation. All of these patients converted to positive PRA assays after CAVF creation with a mean value of 92.3% (median, 98%) at 2.85 months follow-up (median, 1.3 months). The mean PRA value for the control cohort was 5.5% (median, 2.5%), with no patients converting from a nonreactive to a reactive PRA assay during this same time interval. CONCLUSION: The use of dimethyl sulfoxide-cryopreserved cadaveric vein allografts for hemodialysis access leads to broad allosensitization as measured by PRA assay. Cryopreserved cadaveric vein allografts should not be used for hemodialysis access in potential kidney transplant recipients.