The Impact of Human Leukocyte Antigen Mismatching on Sensitization Rates and Subsequent Retransplantation After First Graft Failure in Pediatric Renal Transplant Recipients

Gralla, Jane; Tong, Suhong; Wiseman, Alexander C.

doi:10.1097/tp.0b013e318288ca14

Cited by 60 publications

(61 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HLA-DR matching has been associated with improved graft survival and lower incidence of lymphoma. 17-19 HLA-DR matching has been suggested to improve outcomes in adult heart transplant recipients. 14 The current study suggests that matching at the B locus is independently associated with improved survival, however the hazard ratio 95% confidence interval which approached 1, while matching at the A and DR locus were associated with improved graft survival in univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Association of Human Leukocyte Antigen Donor–Recipient Matching and Pediatric Heart Transplant Graft Survival

Butts

Scheurer

Atz

et al. 2014

Circ: Heart Failure

View full text Add to dashboard Cite

Background The effect of donor-recipient human leukocyte antigen (HLA) matching on outcomes remains relatively unexplored in pediatric patients. The objective of this study was to investigate the effects of donor-recipient HLA matching on graft survival in pediatric heart transplantation. Methods and Results The UNOS database was queried for heart transplants occurring between October 31, 1987 to December 31, 2012 in a recipient aged ≤ 17 with at least one postoperative follow-up visit. Retransplants were excluded. Transplants were divided into 3 donor-recipient matching groups: no HLA matches (HLA-no), 1 or 2 HLA matches (HLA-low), and 3-6 HLA matches (HLA-high). Primary outcome was graft loss. 4471 heart transplants met study inclusion criteria. High degree of donor-recipient HLA matching occurred infrequently; (HLA-high n=269 (6 %) v. HLA-low n=2683 (60%) v. HLA-no n=1495 (34%). There were no differences between HLA matching groups in frequency of coronary vasculopathy (p=0.19) or rejection in the first post-transplant year (p=0.76). Improved graft survival was associated with a greater degree of HLA donor-recipient matching: HLA-high median survival 17.1yrs (14.0-20.2yrs, 95%CI), HLA-low median survival 14.2yrs (13.1-15.4), and HLA-no median survival 12.1yrs (10.9-13.3), p<0.01 log rank test. In Cox-regression analysis, HLA matching was independently associated with decreased graft loss [HLA-low v. HLA-no HR 0.86 (0.74-0.99, 95%CI), p=0.04; HLA-high v. HLA-no 0.62 (0.43-0.90, 95%CI), p<0.01]. Conclusions Decreased graft loss in pediatric heart transplantation was associated with a higher degree of donor-recipient HLA matching, although a difference in the frequency of early rejection or development of coronary artery vasculopathy was not seen.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Human Leukocyte Antigen Donor–Recipient Matching and Pediatric Heart Transplant Graft Survival

Butts

Scheurer

Atz

et al. 2014

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…24-27 Finally, HLA-matching (3+) mostly due to blood-related donation among living donor recipients, conferred a protective effect on graft survival. 28 …”

Section: Discussionmentioning

confidence: 99%

Repeat Kidney Transplantation After Failed First Transplant in Childhood

et al. 2015

View full text Add to dashboard Cite

Background and Objectives Kidney transplant graft survival is almost uniformly superior for initial transplants compared to repeat transplants. We investigate the association between first and second kidney transplant graft survival in patients who underwent initial transplant during their pediatric years and whether age at second transplant is associated with outcome. Design, Setting, Participants, and Measurements This is a retrospective analysis of Organ Procurement and Transplantation Network (OPTN)data from October 1987 to May 2009 examining second kidney graft survival in 2281 patients who received their first transplant at <18 years of age using Kaplan-Meier statistics. Factors associated with second graft survival were identified using a multivariable Cox proportional hazards model. Results Patients with first kidney graft survival of >5 years had better second graft survival compared to patients with first graft survival of 30 days-5 years (p<0.01). Patients with first kidney graft survival less than 30 days had similar second kidney graft outcomes(p=0.50) as those with >5 year first kidney graft survival, demonstrating that very early first graft loss is not associated with poor second transplant outcome. Patients 15-20 years of age at second transplant have lower second graft survival compared to other age groups; p<0.01, regardless of other recipient/donor characteristics and recurrent disease. Conclusions Poor second transplant outcomes are identified among patients with previous pediatric kidney transplant with first graft survival >30 days, but < 5 years, and those receiving second transplants at a high risk age category (15-20 years). These groups may benefit from increased attention both pre- and post-transplant.

show abstract

“…In turn, this increased level of mismatch may drastically decrease the opportunity for a subsequent transplant. Evidence for this was presented in a report by Gralla et al (69) who looked at data for nearly 12,000 pediatric renal transplant patients, 2,704 of whom experienced graft failure and were listed for another transplant. There were 1,847 who were retransplanted.…”

Section: Hla Mismatches and Sensitizationmentioning

confidence: 99%

HLA Mismatching Strategies for Solid Organ Transplantation – A Balancing Act

Zachary

Leffell

2016

Front. Immunol.

View full text Add to dashboard Cite

HLA matching provides numerous benefits in organ transplantation including better graft function, fewer rejection episodes, longer graft survival, and the possibility of reduced immunosuppression. Mismatches are attended by more frequent rejection episodes that require increased immunosuppression that, in turn, can increase the risk of infection and malignancy. HLA mismatches also incur the risk of sensitization, which can reduce the opportunity and increase waiting time for a subsequent transplant. However, other factors such as donor age, donor type, and immunosuppression protocol, can affect the benefit derived from matching. Furthermore, finding a well-matched donor may not be possible for all patients and usually prolongs waiting time. Strategies to optimize transplantation for patients without a well-matched donor should take into account the immunologic barrier represented by different mismatches: what are the least immunogenic mismatches considering the patient’s HLA phenotype; should repeated mismatches be avoided; is the patient sensitized to HLA and, if so, what are the strengths of the patient’s antibodies? This information can then be used to define the HLA type of an immunologically optimal donor and the probability of such a donor occurring. A probability that is considered to be too low may require expanding the donor population through paired donation or modifying what is acceptable, which may require employing treatment to overcome immunologic barriers such as increased immunosuppression or desensitization. Thus, transplantation must strike a balance between the risk associated with waiting for the optimal donor and the risk associated with a less than optimal donor.

show abstract

The Impact of Human Leukocyte Antigen Mismatching on Sensitization Rates and Subsequent Retransplantation After First Graft Failure in Pediatric Renal Transplant Recipients

Abstract: In pediatric recipients, increasing number of initial HLA-DR MMs is associated with HLA sensitization, longer waiting time, decreased rate of retransplant, and decreased regraft survival. Consideration of DR matching at first transplant may mitigate these risks.

Cited by 60 publications

References 22 publications

Association of Human Leukocyte Antigen Donor–Recipient Matching and Pediatric Heart Transplant Graft Survival

Association of Human Leukocyte Antigen Donor–Recipient Matching and Pediatric Heart Transplant Graft Survival

Repeat Kidney Transplantation After Failed First Transplant in Childhood

HLA Mismatching Strategies for Solid Organ Transplantation – A Balancing Act

Contact Info

Product

Resources

About