BACKGROUND: The introduction of human leukocyte antigen (HLA)-matching in nonliving kidney transplantation has resulted into a better graft outcome, but also in an increase of waiting time, especially for patients with rare HLA phenotypes. We addressed the question of the differential influence of HLA-DR-matching versus HLA-A,B in clinical kidney transplantation. METHODS: We used Kaplan-Meier product limit method to estimate survival rates, and Cox proportional hazard regression for the estimation of relative risks (Hazard-ratios) for different variables. RESULTS: A single center study (n=456 transplants, performed between 1985 and 1999) showed that full HLA-DR compatibility leads to a lower incidence of biopsy confirmed acute rejections in the first 180 posttransplantation days. These results were substantiated using the Eurotransplant database (n=39,205 transplants performed between 1985 and 2005) where graft survival in the full HLA-DR compatible group was significantly better than in the incompatible. An additional positive effect of HLA-A,B matching was only found in the full HLA-DR compatible group. In both studies, the introduction of a single HLA-DR incompatibility eliminates the HLA-A,B matching effect. CONCLUSIONS: We propose to allocate postmortem kidneys only to patients with full HLA-DR compatibility, and use HLA-A,B compatibility as an additional selection criterion. All patients, irrespective of their ethnic origin, will profit since the polymorphism of HLA-DR is by far lower than that of HLA-A,B. Excessive kidney travel and cold ischemia time will be significantly reduced.
BACKGROUND: The introduction of human leukocyte antigen (HLA)-matching in nonliving kidney transplantation has resulted into a better graft outcome, but also in an increase of waiting time, especially for patients with rare HLA phenotypes. We addressed the question of the differential influence of HLA-DR-matching versus HLA-A,B in clinical kidney transplantation. METHODS: We used Kaplan-Meier product limit method to estimate survival rates, and Cox proportional hazard regression for the estimation of relative risks (Hazard-ratios) for different variables. RESULTS: A single center study (n=456 transplants, performed between 1985 and 1999) showed that full HLA-DR compatibility leads to a lower incidence of biopsy confirmed acute rejections in the first 180 posttransplantation days. These results were substantiated using the Eurotransplant database (n=39,205 transplants performed between 1985 and 2005) where graft survival in the full HLA-DR compatible group was significantly better than in the incompatible. An additional positive effect of HLA-A,B matching was only found in the full HLA-DR compatible group. In both studies, the introduction of a single HLA-DR incompatibility eliminates the HLA-A,B matching effect. CONCLUSIONS: We propose to allocate postmortem kidneys only to patients with full HLA-DR compatibility, and use HLA-A,B compatibility as an additional selection criterion. All patients, irrespective of their ethnic origin, will profit since the polymorphism of HLA-DR is by far lower than that of HLA-A,B. Excessive kidney travel and cold ischemia time will be significantly reduced.
Authors: Kyung Don Yoo; Junhyug Noh; Hajeong Lee; Dong Ki Kim; Chun Soo Lim; Young Hoon Kim; Jung Pyo Lee; Gunhee Kim; Yon Su Kim Journal: Sci Rep Date: 2017-08-21 Impact factor: 4.379
Authors: Sebastiaan Heidt; Geert W Haasnoot; Marian D Witvliet; Marissa J H van der Linden-van Oevelen; Elena G Kamburova; Bram W Wisse; Irma Joosten; Wil A Allebes; Arnold van der Meer; Luuk B Hilbrands; Marije C Baas; Eric Spierings; Cornelis E Hack; Franka E van Reekum; Arjan D van Zuilen; Marianne C Verhaar; Michiel L Bots; Adriaan C A D Drop; Loes Plaisier; Marc A J Seelen; Jan-Stephan Sanders; Bouke G Hepkema; Annechien J A Lambeck; Laura B Bungener; Caroline Roozendaal; Marcel G J Tilanus; Christina E Voorter; Lotte Wieten; Elly M van Duijnhoven; Marielle A C J Gelens; Maarten H L Christiaans; Frans J van Ittersum; Shaikh A Nurmohamed; Neubury M Lardy; Wendy Swelsen; Karlijn A M I van der Pant; Neelke C van der Weerd; Ineke J M Ten Berge; Frederike J Bemelman; Andries Hoitsma; Paul J M van der Boog; Johan W de Fijter; Michiel G H Betjes; Henny G Otten; Dave L Roelen; Frans H J Claas Journal: Am J Transplant Date: 2019-07-01 Impact factor: 8.086
Authors: Ji Zhang; Dong Liu; Caixin Zhang; Min Zhou; Jian Lv; Hongmei Wang; Hang Yang; Li Fan; Bo Wu; Jingyu Chen Journal: Ann Transl Med Date: 2020-02