HLA-matched kidney transplantation in the era of modern immunosuppressive therapy
Version of Record online: 14 MAY 2010
Copyright © 2010 Wiley Periodicals, Inc.
Dialysis & Transplantation
Volume 39, Issue 5, pages 193–198, May 2010
How to Cite
Amatya, A., Florman, S., Paramesh, A., Amatya, A., McGee, J., Killackey, M., Ren, Q., Alper, B., Heneghan, J., Simon, E., Sullivan, K., Slakey, D. and Zhang, R. (2010), HLA-matched kidney transplantation in the era of modern immunosuppressive therapy. Dial. Transplant., 39: 193–198. doi: 10.1002/dat.20439
- Issue online: 14 MAY 2010
- Version of Record online: 14 MAY 2010
The effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys.
We performed a retrospective analysis of HLA matched (M) and mismatched (MM) kidney transplants in our center. Tacrolimus, mycophenolic acid, and steroids were used as maintenance therapy and basiliximab induction was added for high-risk patients.
A total of 229 kidney transplants were included with median follow-up of 5.1 years. The 5-year death-censored graft survival by Kaplan-Meier method was significantly higher in the M group than in the MM group for deceased-donor kidney transplants (log-rank, p = .018). This graft survival advantage was detected in patients with a peak panel reactive antibody (PRA) greater than 20% (p = .023), but not in those with a PRA level of less than 20% (p = .32). The graft survival was not statistically different for live donor kidney transplants (p = .077). A mismatched kidney was an independent risk for graft loss (hazard ratio: 2.27, 95% confidence interval: 1.009–5.09, p = .047) and acute rejection was a significant cause of graft loss in mismatched deceased-donor transplants (p = .035).
Acute rejection remains a significant cause of graft loss in HLA-6-antigen mismatched deceased-donor kidney transplants. Our data support mandatory sharing of HLA-matched kidneys in sensitized patients with a PRA level greater than 20%.