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- Title
Sharing cross-reactive groups of MHC class I improves long-term graft survival.
- Authors
Sijpkens, Yvo W.J.; Doxiadis, Ilias I.N.; De Fijter, Johan W.; Mallat, Marko J.K.; Van Es, Leendert A.; De Lange, Peter; Zwinderman, Aeilko H.; Westendorp, Rudi G.J.; Van Kemenade, Folkert J.; Bruijn, Jan-Anthonie; Claas, Frans H.J.; Paul, Leendert C.
- Abstract
Sharing cross-reactive groups of MHC class I improves long-term graft survival. Background. Renal transplant loss from chronic rejection remains substantial. To increase our understanding of this syndrome, we identified risk factors predicting late graft loss, with a special emphasis on the impact of human lymphocyte antigen (HLA) matching. Methods. We studied all 654 cadaveric kidney transplants performed in our center between 1983 and 1996 that had survived for more than six months. Eighty-two transplants, lost because of chronic rejection, were used as the outcome variable. The influence of HLA mismatches and shares on long-term graft survival was evaluated at the level of private antigens and cross-reactive groups (CREG) of multiple histocompatibility complex (MHC) class I. HLA and other recipient, donors and transplant parameters were studied using univariate and multivariate Cox regression analysis. Results. The cohort had a mean number of 1.9 HLA mismatches. Because of the homozygosity of HLA antigens, HLA mismatches were not reciprocal to shares. CREG and HLA-A-B mismatches had a relative risk for graft loss of 1.19 (95% CI, 0.97 to 1.45) and 1.05 (0.84 to 1.32) per mismatch. In contrast, the relative risk per shared CREG and broad HLA-A-B antigen was 0.76 (0.63 to 0.92) and 0.79 (0.61 to 1.03). Multivariate analysis revealed that individuals sharing less than four CREGs had a relative risk of 2.13 (1.29 to 3.75) for late graft loss. Other independent predictors were a recipient age of less than 50 years, relative risk 1.95 (1.02 to 3.71); a donor age of more than 50 years, relative risk 1.68 (1.01 to 2.80); acute rejection (vascular vs. no rejection), relative risk 3.52 (1.72 to 7.18); proteinuria (dipstick > 1+ vs. negative), relative risk 2.86 (1.29 to 6.35); and a serum creatinine concentration of more than 150 μmol/liter at six months, relative risk 3.41 (1.96 to 5.94). Conclusion. We identified several coexisting recipient-, donor-, and...
- Subjects
KIDNEY transplantation; GRAFT rejection
- Publication
Kidney International, 1999, Vol 56, Issue 5, p1920
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.1999.00753.x