B. Benedetto et al., Use of cryopreserved cadaveric vein allograft for hemodialysis access precludes kidney transplantation because of allosensitization, J VASC SURG, 34(1), 2001, pp. 139-142
Citations number
24
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background: Dimethyl sulfoxide-cryopreserved cadaveric vein allografts have
recently been proposed as an alternative to prosthetic grafts in the probl
em hemodialysis population. The transfer of mismatched major histocompatibi
lity complex I and II molecules in association with these allografts can po
tentially lead to allosensitization in nonimmunosuppressed individuals.
Methods: In a university-affiliated medical center, 20 consecutive patients
receiving technically successful upper arm cadaveric vein allograft fistul
as (CAVFs) for hemodialysis between April 1999 and April 2000 were studied.
A control cohort of 20 patients on a kidney transplantation waiting list w
as selected by nurses blinded to the study. These patients were matched for
age, sex, history of transfusion, pregnancy, cause of kidney failure, and
prior transplantation. The panel reactive antibody (PRA) values were record
ed in this group over the same time period as the CAVF group.
Results Patients receiving CAVFs had a mean PRA assay value of 84.1% (media
n, 96.5%) at an average of 3.1 months after engraftment (median, 1.5 months
). The preengraftment PRA values were available for seven patients who were
on the transplant waiting list. Six of these patients had nonreactive PRA
assays before CAVF creation. All of these patients converted to positive PR
A assays after CAVF creation with a mean value of 92.3% (median, 98%) at 2.
85 months follow-up (median, 1.3 months). The mean PRA value for the contro
l cohort was 5.5% (median, 2.5%), with no patients converting from a nonrea
ctive to a reactive PRA assay during this same time interval.
Conclusion: The use of dimethyl sulfoxide-cryopreserved cadaveric vein allo
grafts for hemodialysis access leads to broad allosensitization as measured
by PRA assay. Cryopreserved cadaveric vein allografts should not be used f
or hemodialysis access in potential kidney transplant recipients.