Effect of HLA Matching on Pediatric Renal Transplant Graft Survival in China

Zhao, Hairong; Lai, Xiaofeng; Lü, Jie; Lin, Yi Ting; Wang, P.; Zhu, Lihong; Wu, Linwei; Xiao, Zhu; Wang, Q.; Tan, Ming Jen

doi:10.1016/j.transproceed.2017.02.048

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…The full-text review was undertaken for 886 eligible articles; of these 78 articles discussed HLA incompatibility at the level of the antigen mismatch only, 64-141 whereas 163 articles assessed incompatibility by molecular genotyping, molecular mismatch analysis, and/or pretransplant DSA verification by solid-phase and/or by cell-based assays. 3,142-303 The Preferred Reporting Items for Systematic reviews and Meta-Analyses diagram outlining the article selection process is provided in Figure 1. 304…”

Section: Resultsmentioning

confidence: 99%

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

et al. 2022

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Original Clinical Science-GeneralBackground. There is no standard definition for "HLA incompatible" transplants. For the first time, we systematically assessed how HLA incompatibility was defined in contemporary peer-reviewed publications and its prognostic implication to transplant outcomes. Methods. We combined 2 independent searches of MEDLINE, EMBASE, and the Cochrane Library from 2015 to 2019. Content-expert reviewers screened for original research on outcomes of HLA-incompatible transplants (defined as allele or molecular mismatch and solid-phase or cell-based assays). We ascertained the completeness of reporting on a predefined set of variables assessing HLA incompatibility, therapies, and outcomes. Given significant heterogeneity, we conducted narrative synthesis and assessed risk of bias in studies examining the association between death-censored graft failure and HLA incompatibility. Results. Of 6656 screened articles, 163 evaluated transplant outcomes by HLA incompatibility. Most articles reported on cytotoxic/flow T-cell crossmatches (n = 98). Molecular genotypes were reported for selected loci at the allele-group level. Sixteen articles reported on epitope compatibility. Pretransplant donor-specific HLA antibodies were often considered (n = 143); yet there was heterogeneity in sample handling, assay procedure, and incomplete reporting on donor-specific HLA antibodies assignment. Induction (n = 129) and maintenance immunosuppression (n = 140) were frequently mentioned but less so rejection treatment (n = 72) and desensitization (n = 70). Studies assessing death-censored graft failure risk by HLA incompatibility were vulnerable to bias in the participant, predictor, and analysis domains. Conclusions. Optimization of transplant outcomes and personalized care depends on accurate HLA compatibility assessment. Reporting on a standard set of variables will help assess generalizability of research, allow knowledge synthesis, and facilitate international collaboration in clinical trials.

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Section: Resultsmentioning

confidence: 99%

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

et al. 2022

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“…The sample size was small, with a more adverse donor–recipient profile in the tacrolimus group (e.g. higher immunological risk, 32,33 older recipients 34 and more deceased donors 35 ). To address potential confounders, patients were matched pharmacologically in immunosuppressive and induction agents, and multivariate analysis was performed.…”

Section: Discussionmentioning

confidence: 99%

Impact of tacrolimus versus cyclosporine on one-year renal transplant outcomes: A single-centre retrospective cohort study

Ong

Kee

2020

Proceedings of Singapore Healthcare

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Background: Calcineurin inhibitors are the cornerstone of maintenance immunosuppression after kidney transplant. While studies on predominantly Caucasian populations recommend tacrolimus over cyclosporine, the effects on Singapore’s local population remain unclear. Objectives: This study aimed to compare the impact of tacrolimus against cyclosporine on post-transplant outcomes in our local kidney transplant population. Methods: A single-centre retrospective chart review was conducted on ABO- and human leucocyte antigen (HLA)-compatible kidney transplantations between 1 January 2011 and 15 August 2018. Patients who received basiliximab induction, prednisolone, mycophenolate and either tacrolimus or cyclosporine were included and followed up for at least one year. Recipients of transplantations at other institutions or other immunosuppressive regimens were excluded. Patient and graft outcomes and adverse effects were collected. Results: Overall, 120 patients on tacrolimus and 49 on cyclosporine were included. Patients on tacrolimus were older. This group had more deceased donor transplants, a higher proportion with donor-specific antibodies (DSAs) present and more HLA mismatches. There were no differences in patient and graft survival, graft function and acute rejections at one year, despite adjusting for age, transplant type, presence of DSAs and total HLA mismatches. The tacrolimus group had more infectious admissions (odds ratio=0.27, 95% confidence interval 0.098–0.73, p=0.01) after adjusting for age, transplant type, HLA mismatches, presence of DSAs and acute rejections, with increased severity and more opportunistic infections. More patients on cyclosporine required a change to alternative immunosuppressants (p=0.003). Conclusion: Our study demonstrated comparable short-term post-transplant outcomes between cyclosporine and tacrolimus. Tacrolimus appears more tolerable but may be associated with infection risks.

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“…1,21 He had 100 mismatch with the proposed donor. Even single HLA mismatch adversely affects the graft survival (4,(22)(23)(24)(25) (Figure 3). Though in the modern era of immunosuppression, the role of HLA matching has become limited, (26) however it still has a definite role in reducing cumulative drug dose and drug related toxicities.…”

Section: Discussion Of the Casementioning

confidence: 99%

Cross-matches in Transplantation: Each is Complementary to Other

Haque

Rahim

2017

Birdem Med J

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Immune system, which is an obligatory component of bodys defense mechanism, is the main barrier for allogenic transplantation. Perfect selection of donor on the basis of human leucocyte antigen (HLA) compatibility and cross-matching are the key components of successful transplantation. Cross-match eliminates the chance of hyper-acute rejection and also ensures the long term graft survival. In 1960s, T-cell complement-dependent cytotoxicity cross-match was firstintroduced; since then it is mandatory component of transplantation workup process. With the advances of time different newer cross-match technics are evolved for determining the likelihood of donor-specific antibody-mediated responses, including flow cytometric cross-match and virtual cross-match using luminous microbead assay. Flow cytometric cross-match and luminous microbead assay are more sensitive and specific than the previous one, however all are complimentary to each other for final selection of donor recipient couple. This article builds an understanding of modern day cross-match interpretation using a complicated case-based approach.Birdem Med J 2016; 6(2): 118-126

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Effect of HLA Matching on Pediatric Renal Transplant Graft Survival in China

Cited by 5 publications

References 6 publications

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

Impact of tacrolimus versus cyclosporine on one-year renal transplant outcomes: A single-centre retrospective cohort study

Cross-matches in Transplantation: Each is Complementary to Other

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