Graft and patient outcomes of zero-human leucocyte-antigen-mismatched deceased and live donor kidney transplant recipients

Abstract

SummaryGreater compatibility of human leucocyte antigen (HLA) alleles between kidney donors and recipients may lead to improved graft outcomes. This study aimed to compare the incidence of acute rejection and graft failure in zero-HLA-mismatched recipients of living-related (LD) and deceased donor (DD) kidney transplants. Using data from the Australia and New Zealand Dialysis and Transplant Registry, we compared the risk of any acute rejection and biopsy-proven acute rejection (BPAR) and graft failure in recipients of zero-HLA-mismatched kidneys between LD and DD using logistic and Cox regression models. Of the 931 zero-HLA-mismatched recipients transplanted between 1990 and 2012, 19 (2.0%) received kidneys from monozygotic/dizygotic twins (twin), 500 (53.7%) from nontwin LD and 412 (44.3%) from DD. Twin kidney transplant recipients did not experience rejection. Compared to DD transplant recipients, the risk of any acute rejection (adjusted odds ratio 0.52, 95%CI 0.34-0.79, P = 0.002) and overall graft failure (adjusted hazard ratio 0.55, 95%CI 0.41-0.73, P < 0.001) was significantly lower in LD recipients independent of initial immunosuppression, but not for BPAR (adjusted odds ratio 0.52, 95%CI 0.16-1.64, P = 0.263). Zero-HLA-mismatched DD kidney transplant recipients have a significantly higher risk of any acute rejection episodes and graft loss compared to zero-HLA-mismatched LD kidney transplant recipients. A cautious and careful approach in reducing immunosuppression appears to be warranted in this group of transplant recipients.

Durability of the hepatitis B vaccination in pediatric renal transplant recipients

“…Maintenance therapy was not compared given limitations discussed below of the transition of the EMR throughout the study period. No other studies have noted this correlation and its biological plausibility is uncertain considering that recipients of living donor kidneys are less likely to experience rejection and therefore are generally treated with lower levels of immunosuppression than recipients of deceased donor kidneys, although we did not specifically assess this in our cohort . Interestingly, number of pretransplant vaccinations received by the candidate was not associated with SP, and however, complete vaccination data were not available and patients without full vaccination sets were censored for the vaccination statistics.…”

Twin-to-Twin Heart Transplantation: A Unique Event With a 25-Year Follow-Up

“…(Ann Thorac Surg 2017;103:e341-2) Ó 2017 by The Society of Thoracic Surgeons S olid organ transplantation in pediatric patients has been a reality since 1954, when the first kidney transplantation was successfully performed between monozygotic twins. Living donor kidney transplantation between monozygotic or dizygotic twins is still used today and is associated with decreased rates of acute rejection and graft failure [1]. In the following case report, we present the first and only reported instance of dizygotic twin heart transplantation.…”

Application of an epitope‐based allocation system in pediatric kidney transplantation

“…Furthermore, with increasing number of HLA‐DR mismatches (MMs), rates of sensitization increase in pediatric KTRs, which in turn impairs access to second and subsequent transplants by as much as 20% and also reduces the survival of each subsequent graft . The majority of kidney allocation programs base their HLA matching on HLA‐A, HLA‐B, and HLA‐DR antigens, and this is predicated on the improved graft outcomes reported with better HLA matching . With greater understanding of the HLA molecule, its allelic variants, and its three‐dimensional structure, functional epitopes of antibody binding have been defined.…”

“…14,15 The majority of kidney allocation programs base their HLA matching on HLA-A, HLA-B, and HLA-DR antigens, and this is predicated on the improved graft outcomes reported with better HLA matching. 16 With greater understanding of the HLA molecule, its allelic variants, and its three-dimensional structure, functional epitopes of antibody binding have been defined. These functional epitopes may not be specific to individual HLA molecules, but can be shared across different HLA molecules (previously referred to as "public" and "private" antigens).…”