Document Detail

Impact of the delayed graft function in hypersensitized kidney transplant patients.
MedLine Citation:
PMID:  12962745     Owner:  NLM     Status:  MEDLINE    
AIM: The aim was to study the incidence, impact, and association of pretransplantation anti-HLA antibodies and delayed graft function (DGF) on the outcome of cadaver kidney transplants independent of the immunosuppressive therapy. METHODS: Data from 1325 cadaver donor kidneys (February 1975 to December 2002) included the variables of current and peak anti-HLA antibodies, presence of DGF, acute rejection (AR) episodes, patient survival, and graft half-life. RESULTS: DGF (need for dialysis in the first week posttransplantation) ranged between 15% and 40% with a mean of 30% in last 5 years. Eighty-five percent of the candidates on the waiting list for kidney transplants displayed <25% panel reactive antibody (PRA) at transplantation with 4.6% between 26% and 50%, 7.7% between 51% and 75%, and 1.5% >75%. Among the patients who developed DGF, 47% displayed AR compared an incidence of 30% among patients without DGF (P=.0026). The patients displaying >50% PRA (either current or maximum) showed a worse graft survival compared with patients with <50% PRA (log rank, P=.0000). DGF reduced graft survival (P=.04), the difference appearing in the early phase after transplantation. The best outcome was observed in the no DGF-no AR group (half-life, 11.6 years) and the worst results were in the hypersensitized patient groups: peak and current PRA >50% (half-lives of 2.4 and 2.2 years). A multivariate analysis showed that the presence of peak or current PRA >50% is the most important risk factor for graft loss. CONCLUSION: Sensitization is the key factor in graft outcome. Presensitization increases the risk of DGF and DGF increases the incidence of AR and both together produce the worst graft survivals.
M Arias
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  35     ISSN:  0041-1345     ISO Abbreviation:  Transplant. Proc.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-09-09     Completed Date:  2004-05-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1655-7     Citation Subset:  IM    
Servicio de Nefrología, Hospital Universitario Valdecilla, Santander, Spain.
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MeSH Terms
Autoantibodies / blood
Follow-Up Studies
Graft Rejection / epidemiology
HLA Antigens / immunology
Immunosuppressive Agents / therapeutic use
Kidney Transplantation / immunology,  physiology*
Retrospective Studies
Time Factors
Treatment Outcome
Waiting Lists
Reg. No./Substance:
0/Autoantibodies; 0/HLA Antigens; 0/Immunosuppressive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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