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Multivariate analysis of the effectiveness of using antibody induction therapy according to the degree of HLA mismatches.
Transplant Proc 2005; 37(2):886-8TP

Abstract

OBJECTIVE

HLA mismatches have a strong impact on acute rejection and renal allograft survival. The objective of this study was to evaluate the effectiveness of antibody induction according to the degree of HLA mismatches.

METHODS

Of 20,429 deceased donor (DD) transplantations and 12,859 living donor (LD) transplantations reported to the United Network for Organ Sharing (UNOS) between 1999 and 2001, 51% of DD and 45% of LD transplant recipients received induction therapy. Propensity scores (PS) were calculated to indicate independent factors associated with the use of induction. Levels of HLA match examined for DD transplant recipients were 0 ABDR (n = 3239), 0 DR (n = 4210), and DR mismatched transplants (n = 12,980), and 0 (n = 1133), 1 (n = 3836), and 2 (n = 7890) haplotype mismatches for LD transplant recipients. Outcome parameters were reported as hazard ratios (HR) for graft loss and odds ratios (OR) for first-year acute rejection.

RESULTS

Recipients with HLA mismatches were more likely to receive induction antibody for DR mismatch in DDs (PS = 1.11, 95% confidence interval [CI] 1.04-1.19) and for haplotype mismatch in LDs (PS = 1.36, 95% CI 1.22-1.52). Induction reduced the likelihood of acute rejection for DD transplant recipients regardless of the level of HLA mismatch (OR = 0.70; 95% CI 0.57-0.85 in 0 ABDR MM; OR = 0.76, 95% CI 0.64-0.89 in 0 DR MM; and OR = 0.69, 95% CI 0.62-0.77 in DR MM), and for 2 haplotype mismatched LD transplant recipients (OR = 0.82, 95% CI 0.70-0.96); in other LD transplant recipients, reductions in acute rejection rates were observed but not statistically significant. Induction reduced the risk of graft loss for DR mismatched DD transplant recipients by about 12% (HR = 0.88; 95% CI 0.80-0.97).

CONCLUSIONS

Antibody induction resulted in a significant reduction of acute rejection and graft loss for patients with HLA mismatch.

Authors+Show Affiliations

Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. Bunnapradist@cshs.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15848565

Citation

Bunnapradist, S, et al. "Multivariate Analysis of the Effectiveness of Using Antibody Induction Therapy According to the Degree of HLA Mismatches." Transplantation Proceedings, vol. 37, no. 2, 2005, pp. 886-8.
Bunnapradist S, Hong A, Lee B, et al. Multivariate analysis of the effectiveness of using antibody induction therapy according to the degree of HLA mismatches. Transplant Proc. 2005;37(2):886-8.
Bunnapradist, S., Hong, A., Lee, B., & Takemoto, S. K. (2005). Multivariate analysis of the effectiveness of using antibody induction therapy according to the degree of HLA mismatches. Transplantation Proceedings, 37(2), pp. 886-8.
Bunnapradist S, et al. Multivariate Analysis of the Effectiveness of Using Antibody Induction Therapy According to the Degree of HLA Mismatches. Transplant Proc. 2005;37(2):886-8. PubMed PMID: 15848565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multivariate analysis of the effectiveness of using antibody induction therapy according to the degree of HLA mismatches. AU - Bunnapradist,S, AU - Hong,A, AU - Lee,B, AU - Takemoto,S K, PY - 2005/4/26/pubmed PY - 2005/9/27/medline PY - 2005/4/26/entrez SP - 886 EP - 8 JF - Transplantation proceedings JO - Transplant. Proc. VL - 37 IS - 2 N2 - OBJECTIVE: HLA mismatches have a strong impact on acute rejection and renal allograft survival. The objective of this study was to evaluate the effectiveness of antibody induction according to the degree of HLA mismatches. METHODS: Of 20,429 deceased donor (DD) transplantations and 12,859 living donor (LD) transplantations reported to the United Network for Organ Sharing (UNOS) between 1999 and 2001, 51% of DD and 45% of LD transplant recipients received induction therapy. Propensity scores (PS) were calculated to indicate independent factors associated with the use of induction. Levels of HLA match examined for DD transplant recipients were 0 ABDR (n = 3239), 0 DR (n = 4210), and DR mismatched transplants (n = 12,980), and 0 (n = 1133), 1 (n = 3836), and 2 (n = 7890) haplotype mismatches for LD transplant recipients. Outcome parameters were reported as hazard ratios (HR) for graft loss and odds ratios (OR) for first-year acute rejection. RESULTS: Recipients with HLA mismatches were more likely to receive induction antibody for DR mismatch in DDs (PS = 1.11, 95% confidence interval [CI] 1.04-1.19) and for haplotype mismatch in LDs (PS = 1.36, 95% CI 1.22-1.52). Induction reduced the likelihood of acute rejection for DD transplant recipients regardless of the level of HLA mismatch (OR = 0.70; 95% CI 0.57-0.85 in 0 ABDR MM; OR = 0.76, 95% CI 0.64-0.89 in 0 DR MM; and OR = 0.69, 95% CI 0.62-0.77 in DR MM), and for 2 haplotype mismatched LD transplant recipients (OR = 0.82, 95% CI 0.70-0.96); in other LD transplant recipients, reductions in acute rejection rates were observed but not statistically significant. Induction reduced the risk of graft loss for DR mismatched DD transplant recipients by about 12% (HR = 0.88; 95% CI 0.80-0.97). CONCLUSIONS: Antibody induction resulted in a significant reduction of acute rejection and graft loss for patients with HLA mismatch. SN - 0041-1345 UR - https://www.unboundmedicine.com/medline/citation/15848565/Multivariate_analysis_of_the_effectiveness_of_using_antibody_induction_therapy_according_to_the_degree_of_HLA_mismatches_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(04)01523-4 DB - PRIME DP - Unbound Medicine ER -