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Effect of simultaneous presence of anti-blood group A/B and -HLA antibodies on clinical outcomes in kidney transplantation across positive crossmatch: a nationwide cohort study

Title
Effect of simultaneous presence of anti-blood group A/B and -HLA antibodies on clinical outcomes in kidney transplantation across positive crossmatch: a nationwide cohort study
Authors
Kwon, HyunwookKim, Jee YeonKim, Dong HyunKo, YoungminChoi, Ji YoonShin, SungJung, Joo HeeKim, Young HoonHan, Duck JongAhn, CurieChae, Dong WanYang, JaeseokChoi, Bum SoonJung, Cheol WoongKim, Myung SooKwon, Oh JungPark, Jae BermKim, Yeong HoonChoi, SooJinNaHan, Seung YeupLee, Sang HoJeong, Kyung HwanKim, Seung JungJeon, Jin SeokPark, Yeon HoRoh, Young NamLee, Jeong JoonLee, Kang WookKim, Chan DuckPark, Jong WonKim, Joong KyungLee, Dong RyeolLee, Dong WonSeong, Eun YoungKong, Jin MinCho, Hong RaePark, Sung KwangLee, Sam YeolPark, Jung HwanKorean Organ Transplantation Regis
Ewha Authors
김승정
SCOPUS Author ID
김승정scopus
Issue Date
2019
Journal Title
SCIENTIFIC REPORTS
ISSN
2045-2322JCR Link
Citation
SCIENTIFIC REPORTS vol. 9
Publisher
NATURE PUBLISHING GROUP
Indexed
SCI; SCIE; SCOPUS WOS
Document Type
Article
Abstract
ABO-incompatible (ABOi) and positive crossmatch (XM) kidney transplantation (KT) have been considered immunologically challenging. The present study analyzed the clinical outcomes in XM positive KT based on ABO incompatibility. We used data from the Korea Organ Transplantation Registry, a nationwide database, and a single-center registry. A total of 263 patients with positive XM were divided into an ABO compatible (ABOc) & XM positive (ABOc/XM+, n = 176) group and an ABOi & XM positive (ABOVXM+, n = 87) group. The overall rejection rate one year after KT was significantly higher in the ABOi/XM+ group than in the ABOc/XM+ group (P < 0.01). A total of four mortalities occurred, all in the ABOi/XM+ patients (P < 0.01). There were no differences in surgical complications or the occurrence of infection-related complications, including BK virus nephropathy. Multivariate analysis indicated that female vs. male (odds ratio (OR), 2.27; P= 0.03), DSA class I (MFI/1000) (OR, 1.10; P= 0.03), DSA class II (MFI/1000) (OR, 1.10; P < 0.01), and ABOi & XM+ status (OR, 2.38; P < 0.01) were significant risk factors for acute rejection during the year after transplantation. Overall graft survival was inferior in ABOi/XM+ patients than in ABOc/XM+ patients (P= 0.02). ABO incompatibility in XM-positive KT patients was found to be a significant risk factor for the development of rejection within one year after transplantation as well as for long-term graft survival. The anti-blood group A, B and anti-HLA antibodies may show synergistic activity.
DOI
10.1038/s41598-019-54397-3
Appears in Collections:
의과대학 > 의학과 > Journal papers
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