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Impact of human leukocyte antigen-DR mismatch status on kidney graft survival in a predominantly African-American population under the newer immunosuppressive era.
Transplant Proc 2011; 43(5):1544-50TP

Abstract

BACKGROUND

Human leukocyte antigen (HLA)-DR has been shown to be immunogenic and associated with poor long-term graft function. However, under potent induction immunosuppression with antithymocyte globulin, the impact of the HLA-DR remains unclear.

METHOD

We reviewed 672 renal transplant recipients who received their transplants between 1998 and 2007. All patients received antithymocyte globulin as induction therapy followed by tacrolimus + prednisone + mycophenolate mofetil for maintenance immunosuppression. We divided the patients into three groups according to HLA-DR mismatch status (zero, one, or two mismatches).

RESULTS

The three groups were different in total number of mismatches, deceased donor transplant, and delayed graft function, respectively. By Kaplan-Meier survival analysis, actuarial graft survival was significantly lower in the HLA-DR two mismatches group (72%) compared to HLA-DR zero mismatches group (78.5%) or HLA-DR one mismatch group (78.5%; P = .05, by log-rank test). Using Cox regression analysis, the risk of graft failure with two HLA-DR mismatches as compared with zero HLA-DR mismatches was 1.6 (95% confidence interval = 1.0-2.44, P = .049). When adjusted for age, wait time, race, type of transplant, retransplant status, T-cell flow crossmatch, delayed graft function, acute rejection, HLA-A and HLA-B, the effect of HLA-DR on survival was not significant (P = .55).

CONCLUSION

The independent effect of HLA-DR mismatches on adverse graft survival is diminished under potent antibody induction and maintenance immunosuppression in our predominantly African-American population.

Authors+Show Affiliations

Division of Transplantation, Department of Surgery, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21693232

Citation

Karabicak, I, et al. "Impact of Human Leukocyte antigen-DR Mismatch Status On Kidney Graft Survival in a Predominantly African-American Population Under the Newer Immunosuppressive Era." Transplantation Proceedings, vol. 43, no. 5, 2011, pp. 1544-50.
Karabicak I, Adekile A, Distant DA, et al. Impact of human leukocyte antigen-DR mismatch status on kidney graft survival in a predominantly African-American population under the newer immunosuppressive era. Transplant Proc. 2011;43(5):1544-50.
Karabicak, I., Adekile, A., Distant, D. A., O'Shaunessy, D., Lewis, S., Sumrani, N. B., ... Salifu, M. O. (2011). Impact of human leukocyte antigen-DR mismatch status on kidney graft survival in a predominantly African-American population under the newer immunosuppressive era. Transplantation Proceedings, 43(5), pp. 1544-50. doi:10.1016/j.transproceed.2011.01.169.
Karabicak I, et al. Impact of Human Leukocyte antigen-DR Mismatch Status On Kidney Graft Survival in a Predominantly African-American Population Under the Newer Immunosuppressive Era. Transplant Proc. 2011;43(5):1544-50. PubMed PMID: 21693232.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of human leukocyte antigen-DR mismatch status on kidney graft survival in a predominantly African-American population under the newer immunosuppressive era. AU - Karabicak,I, AU - Adekile,A, AU - Distant,D A, AU - O'Shaunessy,D, AU - Lewis,S, AU - Sumrani,N B, AU - Norin,A J, AU - Salifu,M O, PY - 2010/07/06/received PY - 2010/09/23/revised PY - 2011/01/18/accepted PY - 2011/6/23/entrez PY - 2011/6/23/pubmed PY - 2011/10/15/medline SP - 1544 EP - 50 JF - Transplantation proceedings JO - Transplant. Proc. VL - 43 IS - 5 N2 - BACKGROUND: Human leukocyte antigen (HLA)-DR has been shown to be immunogenic and associated with poor long-term graft function. However, under potent induction immunosuppression with antithymocyte globulin, the impact of the HLA-DR remains unclear. METHOD: We reviewed 672 renal transplant recipients who received their transplants between 1998 and 2007. All patients received antithymocyte globulin as induction therapy followed by tacrolimus + prednisone + mycophenolate mofetil for maintenance immunosuppression. We divided the patients into three groups according to HLA-DR mismatch status (zero, one, or two mismatches). RESULTS: The three groups were different in total number of mismatches, deceased donor transplant, and delayed graft function, respectively. By Kaplan-Meier survival analysis, actuarial graft survival was significantly lower in the HLA-DR two mismatches group (72%) compared to HLA-DR zero mismatches group (78.5%) or HLA-DR one mismatch group (78.5%; P = .05, by log-rank test). Using Cox regression analysis, the risk of graft failure with two HLA-DR mismatches as compared with zero HLA-DR mismatches was 1.6 (95% confidence interval = 1.0-2.44, P = .049). When adjusted for age, wait time, race, type of transplant, retransplant status, T-cell flow crossmatch, delayed graft function, acute rejection, HLA-A and HLA-B, the effect of HLA-DR on survival was not significant (P = .55). CONCLUSION: The independent effect of HLA-DR mismatches on adverse graft survival is diminished under potent antibody induction and maintenance immunosuppression in our predominantly African-American population. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/21693232/Impact_of_human_leukocyte_antigen_DR_mismatch_status_on_kidney_graft_survival_in_a_predominantly_African_American_population_under_the_newer_immunosuppressive_era_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(11)00263-6 DB - PRIME DP - Unbound Medicine ER -