Influence of CDC‑XM and HLA compatibility on clinical outcomes in kidney transplant recipients during the post‑operative recovery period: A retrospective analysis
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Kidney transplantation is still the preferred treatment for patients with end-stage kidney failure, and successful transplantation can greatly improve the quality of life as well as the survival rate of patients. Complement-dependent cytotoxicity crossmatch (CDC-XM) and human leukocyte antigen (HLA) typing are two important methods of donor-recipient matching before kidney transplantation, and a low CDC-XM level and better HLA matching is optimal conditions for performing kidney transplantation. The purpose of this study was to explore the effects of CDC-XM levels and HLA matching on early post-operative clinical outcomes in kidney transplant recipients. Methods One hundred and twelve consecutive recipients who underwent allogeneic kidney transplantation were selected and their perioperative as well as post-operative follow-up data were categorized and organized. The data collected included preoperative general information, indicators related to renal function, red blood cell, white blood cell, and blood glucose at each follow-up time point (pre-operative, post-operative 1 day, 2 days, 3 days, 7 days, 1 month, 3 months and 6 months) and the incidence of adverse events after transplantation and their risk factors. First classification was performed according to the CDC-XM levels: CDC >10% (n=16) and CDC ≤10% (n=96). A second distribution of patients was made according to the HLA-A+B+DR mismatch (MM): HLA 0-2 MM (n=20) and HLA 3-6 MM (n=92). During the follow-up period, statistical methods were utilized to compare and systematically analyze the differences in clinical indicators and adverse events between the groups. Results In the two different groups with CDC-XM levels and HLA matching, the differences in the clinical indicators between the groups during the follow-up period were mainly centered on the first week post-transplantation, with the greatest differences in renal function-related indicators, whereas recovery was essentially comparable from one month to six months. The CDC >10% group consisted of all male patients, mainly with HLA-DR and -DQ MM, and most of them were two alleles mismatched. In addition, all patients in this group were not found to have HLA class II antibodies before transplantation. The donor types in the HLA 0-2 MM group were all from living donors and the patients in this group had a CDC ≤10%, while all patients with CDC >10% were HLA 3-6 MM. In the total cohort, 19 (16.9%) patients had developed DGF, and 45 (40.1%) patients had performed pulmonary inflammation. In paired comparisons, the incidence of DGF and pulmonary inflammation was superior in HLA 3-6 MM versus HLA 0-2 MM patients (20.7% vs. 0%, p=0.022; 45.7% vs. 15%, p=0.011). In multivariate analysis, the odds ratio (OR) for recipients aged >40 years was 8.854 (95% CI 1.979-39.604, p=0.004), and the OR for deceased donors was 14.771 (95% CI 1.185-184.113, p=0.036). Conclusions CDC-negative and better HLA matching help to promote the recovery of renal function in kidney transplant recipients in the early post-operative period, along with a lower incidence of adverse events. Recipient age and donor type were independent risk factors for DGF in the multifactorial analysis of adverse events.
Authors: Siqi Xie, Chonghe Xu, Zhongqi Zhu, Chao Qin, Xixi Song, Xin Wang, Wei Xu, Mei Zhu
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408625045