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PROGNOSIS OF KIDNEY ALLOGRAFT SURVIVAL: IMMUNOLOGICAL RISK AND REJECTION TYPE

Abstract

THE AIM: to evaluate the association of pretransplant immunological risk (IR) factors and rejection type with the long-term prognosis of renal allografts (RA). PATIENTS AND METHODS: Among all patients being transplanted in two kidney transplant centers between 2000 and 2013, ninety-three renal allograft recipients with pretransplant panel-reactive antibody (PRA) >0% and 195 patients without PRA were enrolled into the case-control study in a ratio of 1:2 with matching for age, gender, HLA mismatch (HLAMM), and year of transplantation. In both groups, pretransplant IR factors (number of previous transplants and), clinical data, episodes of kidney allograft rejection, and outcomes were recorded. Kaplan-Meier method was used for kidney allograft survival analysis. Multivariate Cox regression analysis was used to estimate the relation of investigated parameters, including IR, to the risk of kidney allograft loss. RESULTS: According to the number of pretransplant immunological factors (previous kidney transplants, PRA level, HLAMM) and its relations to kidney allograft survival in univariate regression all patients were divided into two groups: low IR (0-1 risk factor) (n=191) and high IR (2-3 risk factors) (n=97). Kidney allograft survival in high IR (HR) group was significantly worse than in low IR (LR) group (p log-rank<0,001). Antibody-mediated rejection (AMR) occurred more frequently in HR group than in LR group (p<0,001). In the Cox regression model adjusted for other potential confounders the HR group was associated with twofold increase of relative risk of the allograft loss (p=0,015). AMR (Exp(B)=10,72 (95% CI 4,46-25,74; p<0,001), T-cell mediated rejection (Exp(B)=4,29 (95% CI 1,64-11,22; p=0,003), and donor age (Exp(B)=1,03 (95% CI 1,01-1,05; p=0,002) were independent predictors of allograft survival after adjustment the multivariate model for the rejection type while IR grouping lost its independent prognostic significance. CONCLUSION: Based on the analysis of allograft survival, a simplified approach to the stratification of pretransplant immunological risk is suggested. HR was associated with the allograft failure; however, it was not independently predictive of graft prognosis and seemed to be triggered by AMR occurrence. Therefore, the allograft prognosis assessment in clinical practice should consider pretransplant immunological risks, but high attention has to be paid to post-transplant morphological evaluation of the allograft and monitoring of donor-specific antibodies.

About the Authors

M. . Khrabrova
Pavlov First Saint-Petersburg State Medical University
Russian Federation


V. A. Dobronravov
Pavlov First Saint-Petersburg State Medical University
Russian Federation


A. . Nabokow
Nephrology center of Lower Saxony
Russian Federation


H. -J. Gröne
German center of cancer research
Russian Federation


M. . Hallensleben
Institute of transfusion medicine Hannover Medical school
Russian Federation


A. V. Smirnov
Pavlov First Saint-Petersburg State Medical University
Russian Federation


V. . Kliem
Nephrology center of Lower Saxony
Russian Federation


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Review

For citations:


Khrabrova M., Dobronravov V.A., Nabokow A., Gröne H.-., Hallensleben M., Smirnov A.V., Kliem V. PROGNOSIS OF KIDNEY ALLOGRAFT SURVIVAL: IMMUNOLOGICAL RISK AND REJECTION TYPE. Nephrology (Saint-Petersburg). 2015;19(4):41-50. (In Russ.)

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