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Purpose: Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their living donor. The purpose of this investigation was to evaluate outcomes following PXM renal transplantation despite failure to convert to negative crossmatch (NXM) after desensitization.
Methods: UIH records were retrospectively reviewed to identify subjects that underwent desensitization for a PXM renal transplant between 1/1/00 and 11/1/11. Patients who failed to convert to NXM after desensitization were identified as the non-converted subgroup. Patients who converted to NXM were identified as the converted control group.
Results: A total of 108 PXM patients were transplanted with a desensitization protocol during the study period. Forty-two patients failed to convert to NXM prior to transplant comprising the PXM group. Sixty-six patients successfully converted after desensitization comprising the converted group. Mean GFR at 1 year was 47 in the PXM group and 57 within the control group (p = 0.04). GFR at all other time points only differed significantly at discharge (58 vs. 72, p = 0.04). The percentage of patients with GFR < 30mL/min differed significantly at 1 year alone (23% vs. 6%, p = 0.04). Absolute rejection rates were higher within the PXM group for each type of rejection and at each time point. These differences were not found to be statistically significant. Time to first rejection did not differ significantly between groups. No patient deaths occurred within the PXM and 5 within the converted group at 3 years (p = 0.19). Five graft failures occurred within the PXM versus 2 within the converted group at 3 years (p = 0.06).
Conclusion: Though the PXM group had inferior GFR and rejection data, this did not translate into patient or allograft mortality as rates of patient death or allograft failure were comparable between arms for the first 3 years after transplant.