ORIGINAL ARTICLE
Survival Benefit with Kidney Transplants from HLA-Incompatible Live Donors
BACKGROUND
A report from a high-volume single center indicated a survival benefit of receiving a kidney transplant from an HLA-incompatible live donor as compared with remaining on the waiting list, whether or not a kidney from a deceased donor was received. The generalizability of that finding is unclear.
METHODS
In a 22-center study, we estimated the survival benefit for 1025 recipients of kidney transplants from HLA-incompatible live donors who were matched with controls who remained on the waiting list or received a transplant from a deceased donor (waiting-list-or-transplant control group) and controls who remained on the waiting list but did not receive a transplant (waiting-list-only control group). We analyzed the data with and without patients from the highest-volume center in the study.
RESULTS
Recipients of kidney transplants from incompatible live donors had a higher survival rate than either control group at 1 year (95.0%, vs. 94.0% for the waiting-list-or-transplant control group and 89.6% for the waiting-list-only control group), 3 years (91.7% vs. 83.6% and 72.7%, respectively), 5 years (86.0% vs. 74.4% and 59.2%), and 8 years (76.5% vs. 62.9% and 43.9%) (P<0.001 for all comparisons with the two control groups). The survival benefit was significant at 8 years across all levels of donor-specific antibody: 89.2% for recipients of kidney transplants from incompatible live donors who had a positive Luminex assay for anti-HLA antibody but a negative flow-cytometric cross-match versus 65.0% for the waiting-list-or-transplant control group and 47.1% for the waiting-list-only control group; 76.3% for recipients with a positive flow-cytometric cross-match but a negative cytotoxic cross-match versus 63.3% and 43.0% in the two control groups, respectively; and 71.0% for recipients with a positive cytotoxic cross-match versus 61.5% and 43.7%, respectively. The findings did not change when patients from the highest-volume center were excluded.
CONCLUSIONS
This multicenter study validated single-center evidence that patients who received kidney transplants from HLA-incompatible live donors had a substantial survival benefit as compared with patients who did not undergo transplantation and those who waited for transplants from deceased donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)
Supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK098431 and K24DK10182801, to Dr. Segev; F32DK093218, to Dr. Orandi; and RC1DK086731, to Dr. Montgomery).
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. Montgomery and Segev contributed equally to this article.
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the Scientific Registry of Transplant Recipients.
SOURCE INFORMATION
From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes–Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) — both in Minnesota; the Department of Medicine, Cedars–Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) — all in California; the Department of Surgery, University of Illinois–Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian–Weill Cornell Medical Center (S.K.) — both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) — all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) — both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester (A.B.) — both in Massachusetts; the Department of Surgery, St. Vincent Hospital, Indianapolis (P.W.N.); and the Department of Surgery, Houston Methodist Hospital, Houston (A.O.G.).
Address reprint requests to Dr. Segev at the Department of Surgery, Johns Hopkins University, 720 Rutland Ave., Turner 034, Baltimore, MD 21287, or atdorry@jhmi.edu.
.png)
No hay comentarios:
Publicar un comentario