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

Shi, Xinmiao; Lv, Jicheng; Han, Wenxue; Zhong, Xing; Xie, Xinfang; Su, Baige; Ding, Jie

doi:10.1186/s12882-018-0908-3

Cited by 47 publications

(41 citation statements)

References 44 publications

(51 reference statements)

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“…This led to a significant reduction in acute rejection episodes and improved one‐year renal allograft survival. Nevertheless, recent analyses confirmed that HLA serotype level mismatch remains associated with both acute rejection episodes and graft survival in large cohorts .…”

Section: A Brief Summary Of the Current Understanding Of Alloimmunitymentioning

confidence: 99%

Novel insights into non‐HLA alloimmunity in kidney transplantation

et al. 2019

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Recognition of non-self structures on donor cells represents the main immunological barrier in solid organ transplantation. The human leukocyte antigens (HLA) are considered the most important non-self (allo)antigens in transplantation. Long-term graft attrition is mainly caused by the formation of alloreactive antibodies that are directed against nonself structures (i.e., epitopes) on cell surface proteins. Recently published data provided evidence for a similar importance of non-HLA mismatches between donors and recipients in acute rejection as well as long-term kidney allograft survival. These data suggest a broader concept of immunological non-self that goes beyond HLA incompatibility and expands the current concept of polymorphic non-self epitopes on cell surface molecules from HLA to non-HLA targets. Amino acid substitutions caused by single nucleotide variants in protein-coding genes or complete loss of gene expression represent the basis for polymorphic residues in both HLA and non-HLA molecules. To better understand these novel insights in non-HLA alloimmunity, we will first review basic principles of the alloimmune response with a focus on the HLA epitope concept in donor-specific antibody formation before discussing key publications on non-HLA antibodies.

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Section: A Brief Summary Of the Current Understanding Of Alloimmunitymentioning

confidence: 99%

Novel insights into non‐HLA alloimmunity in kidney transplantation

et al. 2019

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“…HLA mismatch might be one reason for rejection [14,40]. HLA A and especially HLA DR mismatches correlated with a higher incidence of rejection and graft loss [14,16,35,41].…”

Section: Plos Onementioning

confidence: 99%

“…HLA mismatch might be one reason for rejection [14,40]. HLA A and especially HLA DR mismatches correlated with a higher incidence of rejection and graft loss [14,16,35,41]. A low HLA mismatch should therefore be aimed for reduced numbers of rejection and their influence on graft survival [16,41].…”

Section: Plos Onementioning

confidence: 99%

“…To meet this demand, Eurotransplant (ET) introduced the European Senior Program (ESP) in addition to the ET Kidney Allocation System (ETKAS) procedure in 1999 [ 13 ]. It moved the focus from an immunological Human Leukocyte Antigen (HLA)-based allocation to an allocation procedure that emphasizes age and cold ischemia time (CIT) [ 14 ]. Local allocation of grafts ≥65 years to non-immunized elderly recipients (≥65 years) without taking HLA-matching into account should keep CIT as short as possible [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of kidney allograft survival in the Eurotransplant senior program after changing the allocation criteria in 2010—A single center experience

et al. 2020

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The European Senior Program (ESP) aims to avoid waiting list competition between younger and elderly patients applying for renal transplantation. By listing patients �65 years on a separate waiting list and locally allocating of grafts �65 years exclusively to this cohort, waiting and cold ischemia times are predicted to be shortened, potentially resulting in improved kidney transplantation outcomes. This study compared a historic cohort of renal transplant recipients being simultaneously listed on the general and the ESP waiting lists with a collective exclusively listed on the ESP list in terms of surrogates of the transplantation outcome. Methods Total 151 eligible patients � 65 years from Mü nster transplant Center, Germany, between 1999 and 2014 were included. Graft function, graft and patient survival were compared using surrogate markers of short-and long-term graft function. Patients were grouped according to their time of transplantation. Results Recipients and donors in the newESP (nESP) cohort were significantly older (69.6 ± 3.5 years vs 67.1 ± 2 years, p<0.05; 72.0 ± 5.0 years vs 70.3 ± 5.0 years, p = 0.039), had significantly shorter dialysis vintage (19.6 ± 21.7 months vs 60.2 ± 28.1 months, p<0.001) and suffered from significantly more comorbidities (2.2 ± 0.9 vs 1.8 ± 0.8, p = 0.009) than the historic cohort (HC). Five-year death-censored graft survival was better than in the HC, but 5-year graft and patient survival were better in the ESP cohort. After 2005, cold ischemia time between groups was comparable. nESP grafts showed more primary function and significantly better long-term graft function 18 months after transplantation and onwards.

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“…The increased longevity of grafts transplanted in accordance with lower HLA mismatched loci is well-known [41] and has been confirmed in a meta-analysis of over 480 000 transplanted patients. [42] HLA typing and consequent matching of HLA donor-to-recipient phenotype forms an integral part of the bone marrow graft allocation protocol internationally as well as in the SA transplantation fraternity. Among other criteria for patients awaiting transplantation, novel strategies are being employed to establish improved HLA matching between unrelated living donors and recipients.…”

Section: Hla Applicationsmentioning

confidence: 99%