Figure 1
August 1, 2007
We would like to thank all participants in the prospective serum study for their active support. During the last cycle we received well over 1000 sera. Our expectation is that this study will allow us to analyze the temporal relationship of de novo posttransplant antibody production and graft rejection. The answer to that key question is still unknown. For antibodies to become a clinically useful tool for posttransplant monitoring, this temporal relationship must be elucidated. Because of the complexity of the project, an answer can be obtained only through multicenter collaboration. It is for that reason that we appeal to each individual CTS participant to consider joining this important study. It is not too late! All newly transplanted patients can be enrolled. The schedule for obtaining patient sera can be found on the CTS website under "Special Studies". Sera should be stored frozen and shipped to Heidelberg once or twice a year, on or around the shipping dates that are periodically announced. Please join this project with the transplants that are performed at your center during the next few months. Your cooperation will be highly appreciated!
In this newsletter we would like to provide information on graft survival rates that were obtained using organs from non-heart beating donors (NHD), donors with a history of hypertension, or so-called "marginal" donors for other reasons.
Figure 1
As shown in Figure 1, not surprisingly, kidneys from heart beating donors (HD) did better than those from non-heart beating donors, donors with a history of hypertension, and donors categorized as "marginal" for other reasons.
The result was strongly influenced by the age of the donor. Kidneys from non-heart beating donors did relatively well if the donor was younger than 50. However, the success rate decreased substantially if the donor was older than 50 (Figure 2).
Figure 2
We performed an analysis of donor age in non-heart beating donors and heart beating donor controls. As shown in Figure 3, 50 years of age represented a cut-off especially for non-heart beating donors.
Figure 3
A similar analysis of kidneys from donors with a history of hypertension showed a striking influence of age only for donors older than 60 (Figure 4).
Figure 4
The results of a parallel analysis of the influence of donor categorization and age in liver and heart transplantation are shown in Figures 5 and 6.
Figure 5
Figure 6
One can see interesting similarities and dissimilarities. Altogether, it is apparent that donor organs from donors categorized as being at an increased risk yield results that, as expected, are impaired. However, considering the prevailing donor shortage and the clinical circumstances which often mandate transplantation in spite of a non-ideal donor source, the graft survival results appear reasonable.
We are pleased to advise you that a manuscript based on the CTS collaborative serum study and reporting results that were obtained in collaboration with Drs. Stastny and Zou in Dallas was accepted for publication in the New England Journal of Medicine. In it, we report interesting new data on the relevance of non-HLA antibodies in renal transplantation. The manuscript is subject to the usual NEJM embargo but we will forward the paper to you as soon as possible. Our special thanks go to all who provided sera. The results underline the importance of the CTS serum study and provide another reason for those who have not yet joined to do so. Please support this project.
Thank you very much for your cooperation.
Sincerely yours,