HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy
BACKGROUND The effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys. METHOD We performed a retrospective analysis of HLA matched (M) and mismatched (MM) kidney transplants in our center. Tacrolimus, mycophenolic acid, and steroids wer...
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| Veröffentlicht in: | Dialysis & transplantation 2010-05, Vol.39 (5), p.193-198 |
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| creator | Amatya, Arun Florman, Sandy Paramesh, Anil Amatya, Anup McGee, Jennifer Killackey, Mary Ren, Quing Alper, Brent Heneghan, Jean Simon, Eric Sullivan, Karen Slakey, Douglas Zhang, Rubin |
| description | BACKGROUND
The effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys.
METHOD
We 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.
RESULT
A 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).
CONCLUSION
Acute 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%. |
| doi_str_mv | 10.1002/dat.20439 |
| format | Article |
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The effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys.
METHOD
We 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.
RESULT
A 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).
CONCLUSION
Acute 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%.</description><identifier>ISSN: 0090-2934</identifier><identifier>ISSN: 1932-6920</identifier><identifier>EISSN: 1932-6920</identifier><identifier>DOI: 10.1002/dat.20439</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Antibodies ; Data processing ; Donors ; Graft rejection ; Histocompatibility antigen HLA ; Immunosuppressive agents ; Kidney transplantation ; Mycophenolic acid ; Risk factors ; Risk groups ; Steroid hormones ; Survival ; Tacrolimus</subject><ispartof>Dialysis & transplantation, 2010-05, Vol.39 (5), p.193-198</ispartof><rights>Copyright © 2010 Wiley Periodicals, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3029-c59cee013f3edfe30985e82ccb0f5f60d30ffcde4a3f88dc421d7950daba9b053</citedby><cites>FETCH-LOGICAL-c3029-c59cee013f3edfe30985e82ccb0f5f60d30ffcde4a3f88dc421d7950daba9b053</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fdat.20439$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fdat.20439$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids></links><search><creatorcontrib>Amatya, Arun</creatorcontrib><creatorcontrib>Florman, Sandy</creatorcontrib><creatorcontrib>Paramesh, Anil</creatorcontrib><creatorcontrib>Amatya, Anup</creatorcontrib><creatorcontrib>McGee, Jennifer</creatorcontrib><creatorcontrib>Killackey, Mary</creatorcontrib><creatorcontrib>Ren, Quing</creatorcontrib><creatorcontrib>Alper, Brent</creatorcontrib><creatorcontrib>Heneghan, Jean</creatorcontrib><creatorcontrib>Simon, Eric</creatorcontrib><creatorcontrib>Sullivan, Karen</creatorcontrib><creatorcontrib>Slakey, Douglas</creatorcontrib><creatorcontrib>Zhang, Rubin</creatorcontrib><title>HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy</title><title>Dialysis & transplantation</title><description>BACKGROUND
The effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys.
METHOD
We 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.
RESULT
A 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).
CONCLUSION
Acute 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%.</description><subject>Antibodies</subject><subject>Data processing</subject><subject>Donors</subject><subject>Graft rejection</subject><subject>Histocompatibility antigen HLA</subject><subject>Immunosuppressive agents</subject><subject>Kidney transplantation</subject><subject>Mycophenolic acid</subject><subject>Risk factors</subject><subject>Risk groups</subject><subject>Steroid hormones</subject><subject>Survival</subject><subject>Tacrolimus</subject><issn>0090-2934</issn><issn>1932-6920</issn><issn>1932-6920</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNp10L1OwzAQB3ALgUQpDLxBRhjSnu0kxGNVKEWqxECZI9c-q4Z8YSegbDwCz8iT4BJWppNOvzvd_Qm5pDCjAGyuZTdjkHBxRCZUcBZngsExmQAIiJngySk58_4FIElTmk3I03qz-P78qmSn9qijV6trHKLOydq3paw72dmmjmwddXuM0MmoMVHVaHShWVV93fi-bR16b9_xYJxsh3NyYmTp8eKvTsnz6m67XMebx_uH5WITKw5MxCoVChEoNxy1QQ4iTzFnSu3ApCYDzcEYpTGR3OS5Vgmj-kakoOVOih2kfEquxr2ta9569F1RWa-wDHdj0_uCQvg3CyHQQK9HqlzjvUNTtM5W0g0BFYfgihBc8RtcsPPRftgSh_9hcbvYjhM_urxyMA</recordid><startdate>201005</startdate><enddate>201005</enddate><creator>Amatya, Arun</creator><creator>Florman, Sandy</creator><creator>Paramesh, Anil</creator><creator>Amatya, Anup</creator><creator>McGee, Jennifer</creator><creator>Killackey, Mary</creator><creator>Ren, Quing</creator><creator>Alper, Brent</creator><creator>Heneghan, Jean</creator><creator>Simon, Eric</creator><creator>Sullivan, Karen</creator><creator>Slakey, Douglas</creator><creator>Zhang, Rubin</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>201005</creationdate><title>HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy</title><author>Amatya, Arun ; Florman, Sandy ; Paramesh, Anil ; Amatya, Anup ; McGee, Jennifer ; Killackey, Mary ; Ren, Quing ; Alper, Brent ; Heneghan, Jean ; Simon, Eric ; Sullivan, Karen ; Slakey, Douglas ; Zhang, Rubin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3029-c59cee013f3edfe30985e82ccb0f5f60d30ffcde4a3f88dc421d7950daba9b053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Antibodies</topic><topic>Data processing</topic><topic>Donors</topic><topic>Graft rejection</topic><topic>Histocompatibility antigen HLA</topic><topic>Immunosuppressive agents</topic><topic>Kidney transplantation</topic><topic>Mycophenolic acid</topic><topic>Risk factors</topic><topic>Risk groups</topic><topic>Steroid hormones</topic><topic>Survival</topic><topic>Tacrolimus</topic><toplevel>online_resources</toplevel><creatorcontrib>Amatya, Arun</creatorcontrib><creatorcontrib>Florman, Sandy</creatorcontrib><creatorcontrib>Paramesh, Anil</creatorcontrib><creatorcontrib>Amatya, Anup</creatorcontrib><creatorcontrib>McGee, Jennifer</creatorcontrib><creatorcontrib>Killackey, Mary</creatorcontrib><creatorcontrib>Ren, Quing</creatorcontrib><creatorcontrib>Alper, Brent</creatorcontrib><creatorcontrib>Heneghan, Jean</creatorcontrib><creatorcontrib>Simon, Eric</creatorcontrib><creatorcontrib>Sullivan, Karen</creatorcontrib><creatorcontrib>Slakey, Douglas</creatorcontrib><creatorcontrib>Zhang, Rubin</creatorcontrib><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Dialysis & transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Amatya, Arun</au><au>Florman, Sandy</au><au>Paramesh, Anil</au><au>Amatya, Anup</au><au>McGee, Jennifer</au><au>Killackey, Mary</au><au>Ren, Quing</au><au>Alper, Brent</au><au>Heneghan, Jean</au><au>Simon, Eric</au><au>Sullivan, Karen</au><au>Slakey, Douglas</au><au>Zhang, Rubin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy</atitle><jtitle>Dialysis & transplantation</jtitle><date>2010-05</date><risdate>2010</risdate><volume>39</volume><issue>5</issue><spage>193</spage><epage>198</epage><pages>193-198</pages><issn>0090-2934</issn><issn>1932-6920</issn><eissn>1932-6920</eissn><abstract>BACKGROUND
The effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys.
METHOD
We 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.
RESULT
A 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).
CONCLUSION
Acute 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%.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><doi>10.1002/dat.20439</doi><tpages>6</tpages></addata></record> |
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| ispartof | Dialysis & transplantation, 2010-05, Vol.39 (5), p.193-198 |
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| source | Wiley Online Library - AutoHoldings Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Antibodies Data processing Donors Graft rejection Histocompatibility antigen HLA Immunosuppressive agents Kidney transplantation Mycophenolic acid Risk factors Risk groups Steroid hormones Survival Tacrolimus |
| title | HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy |
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