Synergistic impact of pre-sensitization and delayed graft function on allograft rejection in deceased donor kidney transplantation

Author:

Lee Hanbi,Park Yohan,Ban Tae Hyun,Song Sang Heon,Song Seung Hwan,Yang Jaeseok,Ahn Curie,Yang Chul Woo,Chung Byung Ha,Kong Jin Min,Kwon Oh Jung,Kim Deok Gie,Jung Cheol-Woong,Kim Yeong Hoon,Kim Joong Kyung,Kim Chan-Duck,Min Ji Won,Park Sung Kwang,Park Yeon Ho,Berm Park Jae,Park Jung Hwan,Park Jong-Won,Shin Ho Sik,Yoon Hye Eun,Lee Kang Wook,Lee Dong Ryeol,Lee Dong Won,Lee Sam Yeol,Lee Sang-Ho,Lee Su Hyung,Lee Jung Jun,Pyo Lee Jung,Lee Jeong-Hoon,Jeon Jin Seok,Jun Heungman,Jeong Kyunghwan,Chung Ku Yong,Cho Hong Rae,Ki Ju Man,Chae Dong-Wan,Choi Soo Jin Na,Han Duck Jong,Han Seungyeup,Huh Kyu Ha,

Abstract

AbstractThe aim of this study is to investigate whether or not delayed graft function (DGF) and pre-transplant sensitization have synergistic adverse effects on allograft outcome after deceased donor kidney transplantation (DDKT) using the Korean Organ Transplantation Registry (KOTRY) database, the nationwide prospective cohort. The study included 1359 cases between May 2014 and June 2019. The cases were divided into 4 subgroups according to pre-sensitization and the development of DGF post-transplant [non-pre-sensitized-DGF(−) (n = 1097), non-pre-sensitized-DGF(+) (n = 127), pre-sensitized-DGF(−) (n = 116), and pre-sensitized-DGF(+) (n = 19)]. We compared the incidence of biopsy-proven allograft rejection (BPAR), time-related change in allograft function, allograft or patient survival, and post-transplant complications across 4 subgroups. The incidence of acute antibody-mediated rejection (ABMR) was significantly higher in the pre-sensitized-DGF(+) subgroup than in other 3 subgroups. In addition, multivariable cox regression analysis demonstrated that pre-sensitization combined with DGF is an independent risk factor for the development of acute ABMR (hazard ratio 4.855, 95% confidence interval 1.499–15.727). Moreover, DGF and pre-sensitization showed significant interaction (p-value for interaction = 0.008). Pre-sensitization combined with DGF did not show significant impact on allograft function, and allograft or patient survival. In conclusion, the combination of pre-sensitization and DGF showed significant synergistic interaction on the development of allograft rejection after DDKT.

Publisher

Springer Science and Business Media LLC

Subject

Multidisciplinary

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