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Outcomes of Living-Donor Kidney Transplantation in Female Recipients with Possible Pregnancy-Related Pre-Sensitization According to Donor Relationship

 Jee Yeon Kim  ;  Mun Chae Choi  ;  Dong Hyun Kim  ;  Youngmin Ko  ;  Seong Jun Lim  ;  Joo Hee Jung  ;  Hyunwook Kwon  ;  Young Hoon Kim  ;  Sung Shin  ;  Duck Jong Han 
 ANNALS OF TRANSPLANTATION, Vol.25 : e925229, 2020-11 
Journal Title
Issue Date
Female ; Graft Rejection / etiology ; Graft Survival ; HLA Antigens / immunology ; Humans ; Isoantibodies / immunology* ; Kidney Transplantation* ; Living Donors* ; Pregnancy ; Republic of Korea
Allografts ; Kidney Transplantation ; Reproductive History ; Tissue and Organ Procurement
Background: Given that pregnancy is an immune-sensitizing event, female kidney transplant recipients who receive allografts from their offspring or husbands may have a higher risk of rejection and graft failure due to pre-sensitization acquired during pregnancy or childbirth. We investigated the association between donor relatedness (i.e., offspring, husband, unrelated) and graft survival among female living-donor kidney transplant (LDKT) recipients with pregnancy histories. Material/Methods: From January 2009 to January 2018, a total of 2060 LDKTs were performed at Asan Medical Center, Seoul, Korea. After excluding HLA-incompatible transplantation, re-transplantation, and those without a clear history of childbirth, 390 female recipients were included and categorized into group I (offspring-to-mother, n=175), group II (husband-to-wife, n=159), and group III (unrelated, n=56). The primary endpoint was biopsy-proven acute rejection (BPAR) and graft survival. We also evaluated delayed graft function (DGF), death-censored graft failure, and mortality. Results: Group I had the lowest number of HLA mismatches (p<0.001), and group II had the highest number of ABO- incompatible transplantations (p=0.005). At 5 years after transplant, graft survival and death-censored graft survival did not significantly differ among the 3 groups (graft survival: 96.0% vs. 95.5% vs. 93.3%, p=0.685; death-censored graft survival: 98.3% vs. 97.5% vs. 100%, p=0.732). Five-year BPAR-free survival showed no significant differences among the 3 groups (88.6 vs. 88.7 vs. 88.6%, p=0.842). Group II had the highest rate of clinical rejection (p=0.103) and DGF (p=0.174), but the difference was not statistically significant. Conclusions: Female LDKT recipients with possible pregnancy-related pre-sensitization who received grafts from offspring or husbands did not show significantly worse clinical outcomes than those who received grafts from unrelated donors.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Mun Chae(최문채)
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