TY - JOUR T1 - Increase of allosensitization after a kidney graft failure: Predictors and effect on retransplantation outcomes JO - Nefrología T2 - AU - Campos,Andreia AU - Malheiro,Jorge AU - Tafulo,Sandra AU - Santos,Sofia AU - Dias,Leonídeo AU - Martins,La Salete AU - Almeida,Manuela AU - Pedroso,Sofia AU - Henriques,A. Castro AU - Cabrita,António SN - 02116995 M3 - 10.1016/j.nefro.2016.11.020 DO - 10.1016/j.nefro.2016.11.020 UR - https://www.revistanefrologia.com/es-increase-allosensitization-after-kidney-graft-articulo-S0211699517300024 AB - Patients who are candidates for a second kidney transplant (SKT) frequently have a higher level of panel reactive antibodies (PRA). We assessed the allosensitisation change after a first graft failure (GF), its predictors and impact on retransplantat outcomes.We retrospectively selected 140 adult patients who received a SKT. Recipient and donor characteristics were analyzed. We defined the delta PRA (dPRA) as the difference between peak PRA before the SKT and first one (cohort median value=+10%). Logistic regression analysis was used to determine risk factors for dPRA≥10% and acute rejection (AR) in the SKT. Univariable and multivariable Cox analysis was applied to assess independent predictors of second GF.Risk factors for dPRA≥10% at SKT were AR (OR=2.57; P=0.022), first graft survival <1 year (OR=2.47; P=0.030) and ABDR HLA mismatch (OR=1.38 per each mismatch; P=0.038). AR in the SKT was associated with dPRA≥10% (OR=2.79; P=0.047). Induction with a lymphocyte-depleting agent had a protective effect (OR=0.23; P=0.010). SKT survival was lower (P=0.008) in patients with a dPRA≥10% (75.6%, 60.5% in dPRA≥10%; 88.6%, 88.6% in dPRA<10% patients at 5 and 10 years, post-transplant respectively).Multivariable Cox regression showed that dPRA≥10% (HR=2.38, P=0.042), delayed graft function (HR=2.82, P=0.006) and AR (HR=3.30, P=0.001) in the SKT were independent predictors of retransplant failure.This study shows that an increased allosensitisation at retransplant was associated with the degree of HLA mismatch and led to poorer outcomes. De-emphasis of HLA matching in current allocation policies may be undesirable, particularly in patients with a higher chance of needing a SKT. ER -