Use of cryopreserved cadaveric vein allograft for hemodialysis access precludes kidney transplantation because of allosensitization

Citation
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
Journal title
JOURNAL OF VASCULAR SURGERY
ISSN journal
0741-5214 → ACNP
Volume
34
Issue
1
Year of publication
2001
Pages
139 - 142
Database
ISI
SICI code
0741-5214(200107)34:1<139:UOCCVA>2.0.ZU;2-2
Abstract
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.