Long‐term results of living kidney transplantation from HLA‐identical sibling donors under calcineurin inhibitor immunosuppression

Abstract

Background:Recently, it has been revealed that alloantigen-independent causes are important factors for late graft loss in kidney transplantation. We compared the results of living kidney transplantation from HLA-identical siblings with those from HLA-nonidentical siblings to analyse the impact of alloantigen-independent factors on long-term graft survival. Methods: Two hundred and sixty-six recipients who were grafted from their siblings between 1983 and 2002 were subdivided into those transplanted from HLA-identical donors (n = 86) and those from HLA-non-identical donors (n = 180). Results: The incidence of acute rejection was significantly lower in the HLA-identical group than in the HLA-non-identical group (9.3% vs 53.9%, respectively; P < 0.0001). Graft survival was significantly higher in the HLA-identical group than in the HLAnon-identical group (91.3% vs 79.2% at 5 years, 80.3% vs 66.8% at 10 years and 59.1% vs 51.7% at 15 years, respectively; P = 0.0372). Although acute rejection was not seen as a cause of graft loss in the HLA-identical group, death with functioning graft, recurrence of the original disease or chronic allograft nephropathy were observed as the major causes of graft loss in the late period of the HLA-identical group. Conclusion: We concluded that alloantigen-independent causes constitute a crucial factor for graft loss in the late period of HLAidentical kidney transplantation.

Complement related kidney diseases: Recurrence after transplantation

“…Along with the improved control of acute rejections and infections, the recurrence of primary nephropathy has become the most important cause of graft loss principally for patients who have glomerulonephritis (GN) as the primary disease[1,2]. In some series, recurrence of the original disease was reported to be the principal cause of graft loss more than one year after transplantation[2] (Table 1).…”

“…In some series, recurrence of the original disease was reported to be the principal cause of graft loss more than one year after transplantation[2] (Table 1). Some renal diseases have a higher risk of recurrence and recurrence-related graft loss.…”

Kidney transplantation among identical twins: therapeutic dilemmas

“…Contemporary immune suppressive regimens have extended the mean transplant survival time in Poland to 8–10 years 4–6…”

“…However, it was noted that the risk of recurrence of the primary disease, which might have been treated with immune suppression is high 2 6. Moreover, it was observed that during the intrauterine fetus growth DNA mutation is often observed, resulting in phenotypic and genotypic divergence even in homozygous twins.…”

Chimerism and Tolerance Induction in Kidney Transplantation

“…Although there were no major complications, episodes of neutropenic fever, pyelonephritis and viral infections were reported (1 CMV, 1 EBV and 3 varicella zoster). Since the long-term graft survival and overall outcomes of HLA-identical living donor kidney transplants are remarkably good [10], the justification for induction of tolerance in these patients is questionable. The Stanford group also attempted to apply this protocol to the HLA mismatched kidney transplant recipients [11,] but rejection occurred in three of four patients when immunosuppression was tapered [12].…”