Erika L. Wood , Neil Kogut , Lorna Kwan , Julia Burrows , Jeffrey Veale , Erik L Lum
{"title":"加州大学洛杉矶分校HLA匹配活体肾移植受者的临床结果和并发症:回顾性图表回顾","authors":"Erika L. Wood , Neil Kogut , Lorna Kwan , Julia Burrows , Jeffrey Veale , Erik L Lum","doi":"10.1016/j.tpr.2022.100101","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Kidney transplantation between HLA matched siblings results in superior graft survival. It has been hypothesized that the degree of HLA matching in these cases reduces the risk of organ rejection, allowing for reduced immunosuppression exposure. Current tolerance protocols are successful in permitting immunosuppression withdrawal, but require initial exposure to high levels of immunosuppression. Long term data on immunosuppressive complications has not been well studied in this population, and are needed to fully evaluate current tolerance protocols.</p></div><div><h3>Methods</h3><p>In this retrospective cohort, we aimed to evaluate immunosuppression regimens among HLA-matched living kidney transplant recipients. We screened living kidney donor transplant donors-recipient pairs from 2013 to 2019 and found 28 recipients meeting criteria. A retrospective chart review using the electronic medical record was performed evaluating for preoperative clinical factors, cause of ESRD, maintenance immunosuppression regimen, short and long term sequelae of immunosuppression exposure as well as graft outcomes.</p></div><div><h3>Results</h3><p>Median age was 49, half were women and half were non-White (25% Hispanic, 14% Asian/Pacific Islander, 7% other and 4% African American). Median follow up was 3.5 years. Most common causes of ESRD were glomerulonephritis, diabetes and polycystic kidney disease. Over 80% of patients were on calcineurin inhibitor based dual therapy, with approximately 50% on prednisone and the remainder on an anti-metabolite. 14% of first time HLA matched kidney transplant recipients were on 3 immunosuppressive medications. 43% of recipients experienced immunosuppression-related complications, the most common of which was infection, occurring in almost a third of all patients. Graft and overall survival was 100% for this cohort with an average serum creatinine between 1.1 and 1.3 mg/dL at the end of the study period. One patient experienced acute rejection (4%).</p></div><div><h3>Conclusions</h3><p>In our single institution study, a large proportion of HLA matched living kidney transplant recipients experienced complications related to immunosuppression. The majority of patients were on CNI based therapy with a second agent. Additional studies are necessary to determine minimal effective dosing of immunosuppression in HLA matched living donor kidney transplants.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"7 3","pages":"Article 100101"},"PeriodicalIF":0.0000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959622000105/pdfft?md5=48343cedc872285a80513bd1ccfafc3a&pid=1-s2.0-S2451959622000105-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Clinical outcomes and complications of recipients of HLA matched living donor kidney transplants at UCLA: A retrospective chart review\",\"authors\":\"Erika L. Wood , Neil Kogut , Lorna Kwan , Julia Burrows , Jeffrey Veale , Erik L Lum\",\"doi\":\"10.1016/j.tpr.2022.100101\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Kidney transplantation between HLA matched siblings results in superior graft survival. It has been hypothesized that the degree of HLA matching in these cases reduces the risk of organ rejection, allowing for reduced immunosuppression exposure. Current tolerance protocols are successful in permitting immunosuppression withdrawal, but require initial exposure to high levels of immunosuppression. Long term data on immunosuppressive complications has not been well studied in this population, and are needed to fully evaluate current tolerance protocols.</p></div><div><h3>Methods</h3><p>In this retrospective cohort, we aimed to evaluate immunosuppression regimens among HLA-matched living kidney transplant recipients. We screened living kidney donor transplant donors-recipient pairs from 2013 to 2019 and found 28 recipients meeting criteria. A retrospective chart review using the electronic medical record was performed evaluating for preoperative clinical factors, cause of ESRD, maintenance immunosuppression regimen, short and long term sequelae of immunosuppression exposure as well as graft outcomes.</p></div><div><h3>Results</h3><p>Median age was 49, half were women and half were non-White (25% Hispanic, 14% Asian/Pacific Islander, 7% other and 4% African American). Median follow up was 3.5 years. Most common causes of ESRD were glomerulonephritis, diabetes and polycystic kidney disease. Over 80% of patients were on calcineurin inhibitor based dual therapy, with approximately 50% on prednisone and the remainder on an anti-metabolite. 14% of first time HLA matched kidney transplant recipients were on 3 immunosuppressive medications. 43% of recipients experienced immunosuppression-related complications, the most common of which was infection, occurring in almost a third of all patients. Graft and overall survival was 100% for this cohort with an average serum creatinine between 1.1 and 1.3 mg/dL at the end of the study period. One patient experienced acute rejection (4%).</p></div><div><h3>Conclusions</h3><p>In our single institution study, a large proportion of HLA matched living kidney transplant recipients experienced complications related to immunosuppression. The majority of patients were on CNI based therapy with a second agent. Additional studies are necessary to determine minimal effective dosing of immunosuppression in HLA matched living donor kidney transplants.</p></div>\",\"PeriodicalId\":37786,\"journal\":{\"name\":\"Transplantation Reports\",\"volume\":\"7 3\",\"pages\":\"Article 100101\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2451959622000105/pdfft?md5=48343cedc872285a80513bd1ccfafc3a&pid=1-s2.0-S2451959622000105-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2451959622000105\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2451959622000105","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Clinical outcomes and complications of recipients of HLA matched living donor kidney transplants at UCLA: A retrospective chart review
Background
Kidney transplantation between HLA matched siblings results in superior graft survival. It has been hypothesized that the degree of HLA matching in these cases reduces the risk of organ rejection, allowing for reduced immunosuppression exposure. Current tolerance protocols are successful in permitting immunosuppression withdrawal, but require initial exposure to high levels of immunosuppression. Long term data on immunosuppressive complications has not been well studied in this population, and are needed to fully evaluate current tolerance protocols.
Methods
In this retrospective cohort, we aimed to evaluate immunosuppression regimens among HLA-matched living kidney transplant recipients. We screened living kidney donor transplant donors-recipient pairs from 2013 to 2019 and found 28 recipients meeting criteria. A retrospective chart review using the electronic medical record was performed evaluating for preoperative clinical factors, cause of ESRD, maintenance immunosuppression regimen, short and long term sequelae of immunosuppression exposure as well as graft outcomes.
Results
Median age was 49, half were women and half were non-White (25% Hispanic, 14% Asian/Pacific Islander, 7% other and 4% African American). Median follow up was 3.5 years. Most common causes of ESRD were glomerulonephritis, diabetes and polycystic kidney disease. Over 80% of patients were on calcineurin inhibitor based dual therapy, with approximately 50% on prednisone and the remainder on an anti-metabolite. 14% of first time HLA matched kidney transplant recipients were on 3 immunosuppressive medications. 43% of recipients experienced immunosuppression-related complications, the most common of which was infection, occurring in almost a third of all patients. Graft and overall survival was 100% for this cohort with an average serum creatinine between 1.1 and 1.3 mg/dL at the end of the study period. One patient experienced acute rejection (4%).
Conclusions
In our single institution study, a large proportion of HLA matched living kidney transplant recipients experienced complications related to immunosuppression. The majority of patients were on CNI based therapy with a second agent. Additional studies are necessary to determine minimal effective dosing of immunosuppression in HLA matched living donor kidney transplants.
期刊介绍:
To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI