Kidney Transplant with Low Levels of DSA or Low Positive B-Flow Crossmatch: An Underappreciated Option for Highly-Sensitized Transplant Candidates.

Background: Avoiding donor specific antibody (DSA) is difficult for sensitized patients. Improved understanding of the risk of low level DSA is needed. Methods: We retrospectively compared the outcomes of 954 patients transplanted with varied levels of baseline DSA detected by single antigen beads and B flow cytometric crossmatch (XM). Patients were grouped as follows: -DSA/-XM, +DSA/-XM, +DSA/low+XM, +DSA/high+XM, and -DSA/+XM and followed for a mean of 4.1+/-1.9 years (similar among groups, p=0.49). Results: Death-censored allograft survival was similar in all groups except the +DSA/high+XM group, which was lower at 79.1% versus 96.2% in the -DSA/-XM group (p=80% was independently associated with CAMR (HR 5.2, p=0.03) even when DSA was undetected at baseline. By 2 years posttransplant, the incidence of CAMR was 19.4% in patients with cPRA >=80% and undetected DSA and negative XM at baseline. Conclusion: Kidney transplantation with low level DSA with or without a low positive XM is a reasonable option for highly sensitized patients and may be advantageous compared to waiting for a negative XM deceased donor. The risk for CAMR is low in patients with no DSA even if the XM is positive. Patients with cPRA>=80% are at risk for CAMR even if no DSA is detected. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2hh5IgX