Shortened Cold Ischemia Time and Reduced Incidence of Delayed Graft Function for Kidney Transplants Through Enhanced Tissue Compatibility Testing

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Abstract

Introduction

HLA-typing for matching, and prospective leukocyte cross-matching needed for successful deceased donor kidney transplantation (kTX) may delay the onset of operative procedures. We compared kTX cold ischemia times before and after upgrading of histocompatibility tests. The effect of these changes to delayed graft function (DGF), need for post-transplantation dialysis and incidence of early rejections were assessed.

Methods

All recipients of a deceased donor kidney transplant in our center, transplanted between 9.10.2013-16.10.2017 (N=896) were included in this prospective follow-up of an inception cohort. Traditional method of using density gradient-purified spleen cells for cross-matching was replaced on 12th of October 2015 with purification of peripheral blood T- and B-cells for cross-matching using RosetteSep®-kits (Stemcell Technologies). In addition, serology and SSP for donor HLA typing were replaced with LINKSEQ® qPCR method (Linkage Biosciences). Time consumed for laboratory tests was calculated from all suitable deceased donor studies performed at 2014 (n=101) and at 2016 (n=104). Altogether 442 patients received a transplant in the selected era of the old cross-match, and 454 with the new cross-match. DGF was defined as the need for post-transplant dialysis during the first week after transplantation.

Results

Total time consumed for all histocompatibility tests decreased from mean 15 hrs 7 min to 8 hrs 56 min (p<0,001). Reduction was greatest in cross-matches; from mean 8 hrs 51 min to 3 hrs 20 min (p<0,001).

Results

Cold ischemia time shortened from mean 20 hrs 6 min to 15 hrs 52 minutes (p<0,001). The incidence of DGF was significantly reduced from 31% to 24% (P=0.01), whereas the incidence of nonfunction was 1.8% in both groups. Among patients with DGF, the median number of hemodialysis sessions did not differ between the groups (3 sessions in both groups respectively, range 1–30). No significant differences were seen in the frequency of acute cellular rejection (10% vs 13%) or antibody-mediated rejection (5% vs 3%) between patients with the old and new cross-match test.

Conclusion

Optimization of histocompatibility tests help to reduce kTX cold ischemia time and the occurrence of DGF. Future development is warranted to optimize crosstalk between the tissue typing laboratory and transplant center to further minimize the delays.

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