Abstract: TH-PO1169
Kidney Transplantation in Females: Impact of Living Donor Relationship on Outcomes
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Chopra, Bhavna, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
Background
Female kidney transplant recipients(KTRs) are likely exposed to different HLA types through pregnancy and child birth. This may make them susceptible to memory response when re-challenged with same HLA types through organ transplant from child or spouse may increase the risk for rapid development of donor specific antibodies (DSA); increasing risk of early antibody mediated rejection; thus compromising transplant outcomes. To test this, we assessed long-term outcomes in female living donor KTRs based on their relationship to the organ donor.
Methods
Using OPTN/UNOS database, we identified all adult female living donor KTRs from 2001-2015 who received induction and CNI/MMF maintenance. Group was divided based on relationship to the donor: biologically related (sibling vs. child) and unrelated (spouse vs. all other unrelated). A subgroup of the latter was also identified in order to account for donor gender disparity: (spouse vs. unrelated males). Using a Cox model that adjusted for donor, recipient and transplant variables, we calculated overall and death-censored graft failure risks as well as patient death risk for the female recipients based on donor category: sibling vs. child; spouse vs. all unrelated and spouse vs. unrelated males.
Results
The results shown in table 1. Adjusted overall graft failure risk and patient death risk were significantly lower in sibling compared to child in female KTRs.
Conclusion
Increased patient death risk associated with child to mother transplant when compared to sibling could be related to the immunological risk from child as a consequence of maternal exposure to neonatal HLA during delivery. This can lead to DSA formation from memory response increasing risk of humoral injury, microvascular inflammation, leading to worse allograft function which has a graded association with mortality. Siblings on the other hand could have an immunological advantage by being identical twin or by providing 6 antigen match. Interestingly this phenomenon was not observed in spouse to female transplant despite limiting unrelated donor gender to male in order to minimize the impact of renal volume on outcomes.
| Biological category | Living related | Living unrelated | |
| Donor category | Sibling (n=3560) vs. child (n=2852) | Spouse ( n=1405) vs. all unrelated (n=4513) | Spouse (n=1405) vs. male unrelated (n=1453) |
| Overall graft failure risk [HR (95%CI)] | 0.75 (0.59-0.95)* | 1.13 (0.97-1.31) | 1.08(0.89-1.31) |
| Death-censored graft failure risk [HR (95%CI)] | 0.76 (0.56-1.04) | 1.10 (0.92-1.32) | 1.03 (0.81-1.30) |
| Patient death risk [HR (95%CI)] | 0.70 (0.53-0.93)** | 1.07 (0.88-1.31) | 0.93 (0.70-1.22) |
p-value; * = 0.017; ** = 0.015