HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy

Abstract

BACKGROUNDThe effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys.METHODWe performed a retrospective analysis of HLA matched (M) and mismatched (MM) kidney transplants in our center. Tacrolimus, mycophenolic acid, and steroids were used as maintenance therapy and basiliximab induction was added for high‐risk patients.RESULTA total of 229 kidney transplants were included with median follow‐up of 5.1 years. The 5‐year death‐censored graft survival by Kaplan‐Meier method was significantly higher in the M group than in the MM group for deceased‐donor kidney transplants (log‐rank, p = .018). This graft survival advantage was detected in patients with a peak panel reactive antibody (PRA) greater than 20% (p = .023), but not in those with a PRA level of less than 20% (p = .32). The graft survival was not statistically different for live donor kidney transplants (p = .077). A mismatched kidney was an independent risk for graft loss (hazard ratio: 2.27, 95% confidence interval: 1.009–5.09, p = .047) and acute rejection was a significant cause of graft loss in mismatched deceased‐donor transplants (p = .035).CONCLUSIONAcute rejection remains a significant cause of graft loss in HLA‐6‐antigen mismatched deceased‐donor kidney transplants. Our data support mandatory sharing of HLA‐matched kidneys in sensitized patients with a PRA level greater than 20%.

What is the impact of human leukocyte antigen mismatching on graft survival and mortality in renal transplantation? A meta-analysis of 23 cohort studies involving 486,608 recipients

“…Among these studies, 18 studies provided multivariable-adjusted effect estimates [ 19 , 21 – 24 , 27 – 39 ], 3 studies provided both multivariable-adjusted and univariable-unadjusted data [ 20 , 25 , 26 ], and 2 studies provided univariable-unadjusted data [ 40 , 41 ]. Besides, 8 studies were multi-centered [ 19 , 23 , 27 , 32 , 33 , 35 , 37 , 38 ]; another 15 studies were single-centered [ 20 – 22 , 24 – 26 , 28 – 31 , 34 , 36 , 39 – 41 ]. When considering HLA locus as categories, 11 studies reported survival outcomes of all HLA locus (HLA-A, -B and -DR) [ 20 , 23 – 28 , 32 , 35 , 36 , 40 ], 8 [ 19 , 20 , 22 , 29 – 31 , 33 , 41 ] reported HLA-DR locus, 4 with HLA-B locus [ 19 , 30 , 31 , 33 ], and 3 with HLA-A locus [ 30 , 31 , 33 ].…”