TABLE 1.
Baseline characteristics of patients included in our study.
| Baseline characteristics | All patients (n = 353) | No-DSA (n = 304) | Early-DSA (n = 30) | Late-DSA (n = 19) | p |
|---|---|---|---|---|---|
| Recipient age (years) a | 57.0 (45.0–65.0) | 58.0 (46.0–65.0) | 49.5 (41.0–64.2) | 45.0 (32.0–63.0) | 0.235 |
| Recipient sex (male) (n, %) a | 245 (69.4%) | 217 (71.4%) | 17 (56.7%) | 11 (57.9%) | 0.133 |
| Recipient sex (female) (n, %) • Pregnancy before transplant |
108 (30.6%) 65 (60.2%) |
87 (28.6%) 53 (60.9%) |
13 (43.3%) 8 (61.5%) |
8 (42.1%) 4 (50.0%) |
0.133 0.829 |
| Death-censored graft failure (n, %) | 32 (9.1%) | 19 (6.3%) | 6 (20.0%) | 7 (36.8%) | <0.001 |
| Death (n, %) | 37 (10.5%) | 31 (10.2%) | 5 (16.7%) | 1 (5.3%) | 0.406 |
| Donor age (years) a | 55.0 (45.0–63.0) | 55.0 (45.0–63.0) | 55.0 (44.7–63.2) | 52.0 (41.0–69.0) | 0.982 |
| Donor sex (male) (n, %) | 210 (59.5%) | 180 (59.2%) | 18 (60.0%) | 12 (63.2%) | 0.942 |
| Donor type (deceased) (n, %) • DBD (n, %) • DCD (n, %) |
337 (95.5%) 213 (60.3%) 124 (35.1%) |
293 (96.4%) 183 (60.2%) 110 (36.2%) |
27 (90.0%) 18 (60.0%) 9 (30.0%) |
17 (89.5%) 12 (63.2%) 5 (26.4%) |
0.120 0.542 |
| Induction immunosuppression (n, %) • ATG (n, %) • Anti-IL2R (n, %) |
253 (71.7%) 120 (47.4%) 133 (52.6%) |
216 (71.1%) 92 (42.6%) 124 (57.4%) |
23 (76.7%) 18 (78.3%) 5 (21.7%) |
14 (73.7%) 10 (71.4%) 4 (28.6%) |
0.793 0.001 |
| First kidney transplant (n, %) | 257 (72.8%) | 228 (75.0%) | 18 (60.0%) | 11 (57.9%) | 0.069 |
| Retransplant (n, %) • Repeated HLA mismatch with previous donors (n, %) |
96 (27.2%) 30 (31.3%) |
76 (25.0%) 23 (30.3%) |
12 (40.0%) 5 (41.7%) |
8 (42.1%) 2 (25.0%) |
0.069 0.675 |
| Combined transplant (n, %) • Pancreas-kidney (n, %) • Liver-kidney (n, %) |
23 (6.5%) 20 (87.0%) 3 (13.0%) |
20 (6.6%) 17 (85.0%) 3 (15.0%) |
2 (6.7%) 2 (100.0%) 0 (0.0%) |
1 (5.3%) 1 (100.0%) 0 (0.0%) |
0.974 0.772 |
| CIT (hours) a | 19.0 (10.0–23.0) | 19.0 (10.0–23.0) | 20.0 (11.2–22.2) | 12.0 (5.0–22.0) | 0.506 |
| DGF (n, %) | 91 (25.8%) | 82 (27.0%) | 6 (20.0%) | 3 (15.8%) | 0.746 |
| Early blood transfusion (n, %) b | 199 (56.4%) | 169 (55.6%) | 19 (63.3%) | 11 (57.9%) | 0.710 |
| cPRA at the time of transplant (%) a | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 40.4 (0.0–87.8) | 0.0 (0.0–36.3) | <0.001 |
| cPRA ≥5% at the time of transplant (n, %) | 79 (22.4%) | 56 (18.4%) | 17 (56.7%) | 6 (31.6%) | <0.001 |
| cPRA ≥85% at the time of transplant (n, %) | 33 (9.3%) | 24 (7.9%) | 8 (26.7%) | 1 (5.3%) | 0.003 |
| HLA-A mismatch >0 (n, %) | 312 (88.4%) | 266 (87.5%) | 29 (96.7%) | 17 (89.5%) | 0.323 |
| HLA-B mismatch >0 (n, %) | 322 (91.2%) | 277 (91.1%) | 27 (90.0%) | 18 (94.7%) | 0.838 |
| HLA-DRB1 mismatch >0 (n, %) | 297 (84.1%) | 257 (84.5%) | 24 (80.0%) | 16 (84.2%) | 0.810 |
| IS regimen at the time of early HLA screening (n, %) • Tacrolimus, MMF/MPA, prednisone • Tacrolimus, mTORi, prednisone • Others |
344 (97.5%) 7 (2.0%) 2 (0.6%) |
296 (97.4%) 7 (2.3%) 1 (0.3%) |
29 (96.7%) 0 (0.0%) 1 (3.3%) |
19 (100.0%) 0 (0.0%) 0 (0.0%) |
0.748 0.562 0.106 |
| Early HLA screening only by protocol (n, %) | 297 (84.1%) | 260 (85.5%) | 22 (73.3%) | 15 (78.9%) | 0.178 |
| Plasmapheresis before early HLA screening (n, %) c | 35 (9.9%) | 26 (8.6%) | 7 (23.3%) | 2 (10.5%) | 0.035 |
| IVIG before early HLA screening (n, %) c | 30 (8.5%) | 21 (6.9%) | 7 (23.3%) | 2 (10.5%) | 0.008 |
| ABMR (Banff 2019 Classification) (n, %)
d
• Time from transplant to ABMR (months) a |
69 (19.5%) 3.3 (0.6–12.1) |
38 (12.5%) 2.7 (0.5–12.0) |
16 (53.3%) 1.7 (0.5–3.6) |
15 (78.9%) 11.4 (1.5–35.7) |
<0.001
0.027 |
| Biopsy with ABMR diagnosis by clincal indication or 1-year protocol • Clinical indication (graft dysfunction and/or DSA appearance) (n, %) - Only for DSA (n, %) - Graft dysfunction (n, %) • 1-year-Protocol (n, %) |
54 (78.3%) 15 (21.7%) |
26 (68.4%) 12 (31.6%) |
16 (100.0%) 5 (31.3%) 11 (68.8%) 0 (0.0%) |
12 (80.0%) 2 (16.7%) 10 (83.3%) 3 (20.0%) |
0.036 |
| TCMR (Banff 2019 Classification) (n, %) d | 96 (27.2%) | 75 (24.7%) | 11 (36.7%) | 10 (52.6%) | 0.014 |
Median and interquartile range. For continuous variables with non-normal distribution, the Kruskal-Wallis test was used to compare the 3 groups.
Early blood transfusion: at least one blood transfusion within the first 30 days after transplant.
Treatment with plasmapheresis and/or IVIG, before the first early HLA, determination was performed as rejection prophylaxis in high-risk patients, suspected rejection and inability to perform a biopsy, or biopsy-proven ABMR.
Rejection episodes were categorized according to Banff 2019 Classification. Borderline rejection was included in the category of T-cell mediated rejection (TCMR).
DBD: donor brain death. DCD: donor circulatory death. ATG, antithymocyte globulin; Anti-IL2R, anti-interleukin-2, receptor. CIT: cold ischemia time. DGF: delayed graft-function. cPRA: calculated panel-reactive antibody (Eurotransplant). IS: immunosuppression. MMF/MPA: Mycophenolate mofetil/Mycophenolic acid. mTORi: mTOR, inhibitor. IVIG: Intravenous immunoglobulin. ABMR: antibody-mediated rejection. TCMR: T-cell mediated rejection.