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Multicenter Study
. 2022 Oct 3:13:997364.
doi: 10.3389/fimmu.2022.997364. eCollection 2022.

Atopy as an independent predictor for long-term patient and graft survival after kidney transplantation

Raphaël Porret  1 , Raphaël P H Meier  2 , Josip Mikulic  3 , Manuel Pascual  3 , Vincent Aubert  1 , Thomas Harr  4 , Déla Golshayan  3 , Yannick D Muller  1
Affiliations
Multicenter Study

Atopy as an independent predictor for long-term patient and graft survival after kidney transplantation

Raphaël Porret et al. Front Immunol. .

Erratum in

Abstract

Background: Atopy is a genetic condition predisposing individuals to develop immunoglobulin E (IgE) against common allergens through T-helper 2 (Th2) polarization mechanisms. The impact of atopy on graft survival in solid organ transplantation is unknown.

Methodology: We analyzed 268 renal allograft recipients from the Swiss Transplant Cohort Study, a prospective multicenter cohort studying patients after solid organ transplantation, with a 9-year median follow-up (IQR 3.0). We used the Phadiatop assay to measure IgE antibodies against a mixture of common inhaled allergens (grass, tree, herbs, spores, animals, and mites) to identify pre-transplantation atopic patients (>0.35 KU/L).

Results: Of 268 kidney transplant recipients, 66 individuals were atopic (24.6%). Atopic patients were significantly younger than non-atopic patients (49.6 vs 58.0 years old, P = 0.002). No significant difference was found for gender, cold/warm ischemia time, preformed donor-specific antibodies (DSA), HLA mismatches, induction and maintenance immunosuppressive therapy, CMV serostatus, or cause of kidney failure. Patient and graft survival at ten years of follow-up were significantly better in the atopic group, 95.2% versus 69.2% patient survival (P < 0.001), and 87.9% versus 60.8% graft survival (P < 0.001), respectively. A multivariate Cox analysis revealed that atopy predicted recipient and graft survival independently of age and living donor donation. Finally, we found similar rates of biopsy-proven acute cellular and antibody-mediated rejections between atopic and non-atopic recipients.

Conclusion: Atopy was associated with better long-term patient and graft survival, independently of age and living donor donation after kidney transplantation. Yet, atopy should not be used as a predictor for acute rejection.

Keywords: atopy; graft survival; kidney; patient survival; rejection; survival; transplantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Open access funding provided by University of Lausanne.

Figures

Figure 1
Figure 1
Kaplan-Meier estimates of ten-year follow-up. (A) Patient survival, and (B) kidney graft survival. The calculated p-values were obtained by the log-rank test (univariate analysis). Age-adjusted p-values were calculated with multivariate Cox proportional hazards regression analysis. 95% confidence intervals are represented according to the group color.
Figure 2
Figure 2
Kaplan-Meier estimates of ten-year follow-up stratified by atopic grade. (A) Number of patients in each subgroup based on Phadiatop grading. (B) Patient survival and (C) graft survival across all groups. The calculated p-values were obtained by the log-rank test (univariate analysis).
Figure 3
Figure 3
Biopsy-proven rejections in atopic and non-atopic groups. (A) Ten-year cumulative events of ACR and AMR according to the atopic status. (B) Banff score comparison of kidney biopsies in non-atopic and in atopic patients. Bars represent the average score of all biopsies performed in the non-atopic and atopic patients during follow-up. Intervals represent the standard error of the mean. C4d, C4d deposition; ptc, peritubular capillaritis; g, glomerulitis; ti, total inflammation; i, interstitial inflammation; cg, glomerulopathy; cv, fibrous intimal thickening; t, tubulitis; v, intimal arteritis; mm, mesangial matrix increase; ci, interstitial fibrosis; ct, tubular atrophy; ah, arteriolar hyalinosis; aah, alternative arteriolar hyalinosis.
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