HLA‐A incompatibility associated with enhanced long‐term renal graft survival in HLA‐B, DR mismatched transplants

Abstract

SummaryThe effect of HLA-A matching on long-term cadaver kidney graft survival was analysed, on average, 6 years after transplantation in a total of 1085 cyclosporine (CyA)-treated patients.A beneficial effect of HLA-A mismatching on graft survival was found by univariate and multivariate analyses (?< 0.05).Enhanced graft survival was associated with HLA-A mismatching in transplants mismatched for HLA-B,DR (/*= 0.03), but not in HLA-B,DR compatible transplants.High 6 year graft survival rates, 78% and 66%. were found in transplants mismatched for two or one HLA-A antigens, respectively, among patients without any acute rejection episode. This was significantly higher than the survival rate of 55% found in HLA-A compatible transplants iP = 0.00\). In patients who had suffered from acute rejection episodes, a prolonged graft survival was also associated with HLA-A mismatching in HLA-B.DR mismatched transplants {P-0.04).The beneficial effect on graft survival of HLA-A mismatching was most pronounced in patients treated with high/medium dose CyA and prednisolone {P = 0.004 overall and P = 0.0007 for HLA-B,DR mismatched transplants).In conclusion. HLA-A mismatching was associated with enhanced long-term renal graft survival in CyA-treated recipients of HLA-B,DR mismatched transplants. In clinical situations, the present results might, if confirmed, contribute to the prolongation of long-term graft survival. The results might indicate the existence of tolerance promoting allogeneic markers within the HLA-A class I region.

Analysis of the Influence of HLA-A Matching Relative to HLA-B and -DR Matching on Heart Transplant Outcomes

“…Bucin et al 14 previously showed a favorable effect of HLA-A–incompatible grafts on long-term renal graft survival in cyclosporine (CYA)-treated recipients of HLA-B,DR–incompatible transplants. It was hypothesized that incompatibility between donor and recipient for HLA-A–related antigens induces a downregulatory reaction on the immune response to incompatible HLA-B and HLA-DR antigens.…”