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Delayed graft function and acute rejection following HLA-incompatible living donor kidney transplantation.
Motter, Jennifer D; Jackson, Kyle R; Long, Jane J; Waldram, Madeleine M; Orandi, Babak J; Montgomery, Robert A; Stegall, Mark D; Jordan, Stanley C; Benedetti, Enrico; Dunn, Ty B; Ratner, Lloyd E; Kapur, Sandip; Pelletier, Ronald P; Roberts, John P; Melcher, Marc L; Singh, Pooja; Sudan, Debra L; Posner, Marc P; El-Amm, Jose M; Shapiro, Ron; Cooper, Matthew; Verbesey, Jennifer E; Lipkowitz, George S; Rees, Michael A; Marsh, Christopher L; Sankari, Bashir R; Gerber, David A; Wellen, Jason R; Bozorgzadeh, Adel; Gaber, A Osama; Heher, Eliot C; Weng, Francis L; Djamali, Arjang; Helderman, J Harold; Concepcion, Beatrice P; Brayman, Kenneth L; Oberholzer, Jose; Kozlowski, Tomasz; Covarrubias, Karina; Massie, Allan B; Segev, Dorry L; Garonzik-Wang, Jacqueline M.
Afiliação
  • Motter JD; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Jackson KR; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Long JJ; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
  • Waldram MM; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Orandi BJ; Department of Surgery, University of Alabama, Birmingham, Alabama, USA.
  • Montgomery RA; New York University Langone Medical Center, The NYU Transplant Institute, New York, New York, USA.
  • Stegall MD; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
  • Jordan SC; Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, California, USA.
  • Benedetti E; Department of Surgery, University of Illinois-Chicago, Chicago, Illinois, USA.
  • Dunn TB; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Ratner LE; Department of Surgery, Columbia University Medical Center, New York, New York, USA.
  • Kapur S; Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, New York, USA.
  • Pelletier RP; Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
  • Roberts JP; Department of Surgery, University of California-San Francisco, San Francisco, California, USA.
  • Melcher ML; Department of Surgery, Stanford University, Palo Alto, California, USA.
  • Singh P; Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
  • Sudan DL; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
  • Posner MP; Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
  • El-Amm JM; Integris Baptist Medical Center, Transplant Division, Oklahoma City, Oklahoma, USA.
  • Shapiro R; Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA.
  • Cooper M; Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA.
  • Verbesey JE; Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA.
  • Lipkowitz GS; Department of Surgery, Baystate Medical Center, Springfield, Massachusetts, USA.
  • Rees MA; Department of Urology, University of Toledo Medical Center, Toledo, Ohio, USA.
  • Marsh CL; Department of Surgery, Scripps Clinic and Green Hospital, La Jolla, California, USA.
  • Sankari BR; Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Gerber DA; Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
  • Wellen JR; Department of Surgery, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
  • Bozorgzadeh A; Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA.
  • Gaber AO; Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA.
  • Heher EC; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Weng FL; Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
  • Djamali A; Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.
  • Helderman JH; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Concepcion BP; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Brayman KL; Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
  • Oberholzer J; Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
  • Kozlowski T; Department of Surgery, University of Florida, Gainesville, Florida, USA.
  • Covarrubias K; Department of Surgery, University of California San Diego, San Diego, California, USA.
  • Massie AB; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Segev DL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Garonzik-Wang JM; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
Am J Transplant ; 21(4): 1612-1621, 2021 04.
Article em En | MEDLINE | ID: mdl-33370502
ABSTRACT
Incompatible living donor kidney transplant recipients (ILDKTr) have pre-existing donor-specific antibody (DSA) that, despite desensitization, may persist or reappear with resulting consequences, including delayed graft function (DGF) and acute rejection (AR). To quantify the risk of DGF and AR in ILDKT and downstream effects, we compared 1406 ILDKTr to 17 542 compatible LDKT recipients (CLDKTr) using a 25-center cohort with novel SRTR linkage. We characterized DSA strength as positive Luminex, negative flow crossmatch (PLNF); positive flow, negative cytotoxic crossmatch (PFNC); or positive cytotoxic crossmatch (PCC). DGF occurred in 3.1% of CLDKT, 3.5% of PLNF, 5.7% of PFNC, and 7.6% of PCC recipients, which translated to higher DGF for PCC recipients (aOR = 1.03 1.682.72 ). However, the impact of DGF on mortality and DCGF risk was no higher for ILDKT than CLDKT (p interaction > .1). AR developed in 8.4% of CLDKT, 18.2% of PLNF, 21.3% of PFNC, and 21.7% of PCC recipients, which translated to higher AR (aOR PLNF = 1.45 2.093.02 ; PFNC = 1.67 2.403.46 ; PCC = 1.48 2.243.37 ). Although the impact of AR on mortality was no higher for ILDKT than CLDKT (p interaction = .1), its impact on DCGF risk was less consequential for ILDKT (aHR = 1.34 1.621.95 ) than CLDKT (aHR = 1.96 2.292.67 ) (p interaction = .004). Providers should consider these risks during preoperative counseling, and strategies to mitigate them should be considered.
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Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Transplante de Rim Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Am J Transplant Assunto da revista: TRANSPLANTE Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos
Texto completo
Adicionar na Minha BVS
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XML
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Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Transplante de Rim Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Am J Transplant Assunto da revista: TRANSPLANTE Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos