HLA class I residue mismatch and renal graft outcome

Abstract

Donor-recipient HLA matching was retrospectively evaluated in 111 cadaveric renal transplants using Takemoto's ten-residue model in which HLA class I antigens are clustered by crossreactive group (CREGs) on the basis of amino acid sequence homology and the sharing of a particular public epitope. The grade and type of HLA residue mismatching were correlated to posttransplant, class I donor-specific antibody production (monitored by flow cytometry crossmatch), rejection occurrence and clinical outcome during the 1st year posttransplant. In 52 patients with 0 mismatchings (MMs) we observed a low incidence of rejection (11.1%) and antibody production (11.1%) for 0 CREG MM grade, while 1 MM was enough to increase immune response against graft (rejection 35%; antibodies 30%). Moreover, a significant correlation was observed between Q144, E163, Q62 and L82/R82 epitopes and the incidence of acute rejection and antibody production ("immunogenic" residues) in patients grouped for a single residue mismatch.

Safety and efficacy of alemtuzumab in the treatment of late acute renal allograft rejection

“…Other causes of late AR include changes in metabolism or absorption of drugs with time or drug–drug interactions or CMV (27) or EBV infections (28). Some studies showed association between young recipient age, old donor age, female donors, and class I CREG (cross‐reactive group) mismatches (29, 30) and late AR episodes. In this case series, recurrent episodes of late AR were precipitated by non‐adherence with maintenance IS in two adolescents, and possible immunostimulation caused by the concomitant use of melatonin in the young child (31).…”