Three year outcomes following positive cross match renal transplantation despite failure to convert to Negative Flow Cross Match after Desensitization

Abstract

Purpose: To determine outcomes of positive crossmatch (PXM) renal transplant recipients that failed to convert to a negative flow cytometry crossmatch (FCXM) despite desensitization. Method(s): A search of UI Health transplant records was performed to identify patients that underwent desensitization before PXM renal transplant between 1/1/00 and 11/1/11. Patients receiving a transplant despite failure to convert to negative FCXM were identified for analysis (not converted group). Patients who converted to negative FCXM after desensitization comprised the control arm. The primary endpoint is mean eGFR. Secondary outcome measures include % eGFR < 30mL/min, patient and graft survival, episodes of rejection, and all measures were assessed at 6 months, 1 year, and 3 years post-transplant. Result(s):108 patients were desensitized before PXM transplant, (not converted group=42; converted group=66) (Table presented). Conclusion(s): Mean eGFR was comparable between groups at all time points, and 3-year eGFR was 57.8 mL/min vs. 57.1 mL/min, p = 0.91. Patients with eGFR < 30mL/min at 3 years did not differ significantly (28% vs. 14%, p = 0.15). Biopsyproven rejection rates were numerically higher within the not converted group for each type of rejection and time point, but the values did not differ significantly. Three-year BPAMR was 24% in the not converted group vs. 18% (p = 0.48). Opportunistic infections rates were comparable. Patient survival (95% vs. 91%) and death-censored allograft survival (84% vs. 95%, p=0.07) were similar between arms at 3 years post-transplant.