Dr.Ahmed Aldajani

Dr.Ahmed Aldajani |Clyto Access

King Fahad Specialist Hospital Dammam,Saudi Arabia





Title: Outcome of HLA incompatible kidney transplants who received desensitization protocol in King Fahad Specialist Hospital Dammam, KSA


Increasing number of potential kidney transplant recipients is sensitized to HLA antigens. Many of them have potential living donors ready but excluded because of  a positive cross-match. Expansion of donor pool by overcoming HLA incompatibility (HLAi) barrier is important to offer more ESRD sufferers the chance of getting kidney transplantation. 
We studied 30 HLAi and 189 HLA compatible kidney transplants recipients from Jun ’11 to Aug ’13 with a median follow-up of 16 (3-27) months. We used our desensitization protocol for HLAi recipients. All HLAi patients received Antithymoglobulin (ATG) as induction while HLA compatible patients received either ATG or basiliximab .We looked at the incidence rate of rejection (Antibody Mediated Rejection (AMR) and Acute Cellular Rejection (ACR)), as the primary end point. We compared primary end point for HLAi patients with those of HLA compatible living related transplants recipients (deceased donor transplants were excluded).

Incidence of ACR was 23.3% in HLAi group compared to 14.8%  in HLA compatible group (p>0.05). Whereas, incidence of AMR was 16.6% in HLAi group compared to 1.5% in HLA compatible group (p=0.01).   Incidence of BK virus infection was comparable (3.3% in HLAi group and 3.1% in HLA compatible group, p=0.7). During the follow-up period, there was no patient/graft loss in any HLAi recipients.
Multivariable analysis showed that the HLAi transplant is a significant risk factors for both ACR and AMR when adjusted for age, gender, DGF, and biologic induction therapy kept into the model ( P<.05)

These results support the fact that living-related HLAi kidney transplantation after desensitization has a comparable graft and patient survival outcomes with those of HLA compatible transplants, comparable incidence of ACR and a higher incidence of AMR, and provide a significant survival benefit as compared to waiting for a compatible organ.
Key words:  HLA , incompatible, kidney, transplantation, outcome.


Related Conferences :

Global Forum on Transplantation Research and Technologies