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A 5 YEAR SINGLE CENTER REVIEW OF GRAFT SURVIVAL IN SENSITIZED RENAL TRANSPLANT RECIPIENTS.
J.D.L. Nolen 1, R.A. Bray 1, T. Pearson 2, C. Larsen 2, K. Newell 2, K. Kokko 3, A. Guasch 3, P. Tso 2 and H.M. Gebel 1. 1 Pathology, Emory University ; 2 Surgery, Emory University and 3 Medicine, Emory University .
A third of the patients awaiting renal transplantation from deceased donors (DD) are sensitized (PRA> 30%), but only 12% of this group is ultimately transplanted. Based on 2003 UNOS data, sensitized patients are transplanted at half the rate of unsensitized patients. Previous reports indicate that, compared to unsensitized patients, graft survival is significantly poorer among sensitized patients. Our transplant center performed 492 adult renal transplants from DD over the past 5 years. Approximately 25% of the recipients were sensitized, a figure double that of the national average. Detailed flow cytometric analysis for antibody specificities was performed on each patient and transplants were only performed when the flow cytometric T and B cell crossmatch was negative. Using graft failure, patient death, or GFR less than 15 mL/min/1.73 m2 as indicators, we compared graft survival/function among sensitized (n=120) and unsensitized (n=372) recipients. The 5-year survival was 70% for each group, exceeding the national average of 65.7% (OPTN/SRTR 2003 data). Our three month and one year graft survival of 97% and 92% were also above the national averages of 94% and 89%, respectively. Thus, in contrast to previously published reports, our data reveal no significant difference in graft survival/function between sensitized and unsensitized patients at any time point in the study. We believe a major factor contributing to our success among sensitized patients is the application of flow cytometric methods for antibody identification and lymphocyte crossmatching and a stringent adherence to transplanting only crossmatch negative patients.