PMID- 10693641
OWN - NLM
STAT- MEDLINE
DCOM- 20000308
LR  - 20191103
IS  - 0902-0063 (Print)
IS  - 0902-0063 (Linking)
VI  - 14
IP  - 1
DP  - 2000 Feb
TI  - Successful cadaveric renal transplantation of patients highly sensitized to HLA 
      Class I antigens.
PG  - 79-84
AB  - The purpose of our investigation was to evaluate long-term graft survival and the 
      role of histocompatibility in patients who were highly sensitized to human 
      leukocyte antigen (HLA) Class I antigens and received a cadaveric renal 
      transplant. Our multi-institutional study evaluated 7-yr graft outcomes and the 
      histocompatibility requirements of 61 (6.1%) highly sensitized (anti-human 
      globulin panel reactive antibody [AHG PRA], > or = 80%) cadaveric renal 
      transplantation patients, transplanted between 1988 and 1997, among 999 
      consecutive cadaveric renal transplants. One- and 7-yr graft survival in the high 
      PRA group (n = 61) was 76 and 59%, and was not significantly different from that 
      in the low PRA group (n = 938), 86 and 59% (Wilcoxon = 0.11; log-rank = 0.45) 
      (died with a functioning graft [DWFG] not censored). When those data were divided 
      into primary and regrafts, 1- and 7-yr graft outcomes for high and low PRA groups 
      were not significantly different [(primary, 1- and 7-yr survival: high PRA = 83 
      and 74%, n = 30, and low PRA = 87 and 61%, n = 825; log-rank = 0.37 for DWFG not 
      censored) (regrafts, 1- and 7-yr survival: high PRA = 70 and 42%, n = 31, and low 
      PRA = 80 and 43%, n = 113; log-rank = 0.36 for DWFG not censored)]. We did 
      observe a subgroup of the high PRA patient group that had inferior graft 
      outcomes. Graft outcome at 1 and 6 yr in the high PRA group for patients who had 
      one to two DR mismatches (65 and 50%, n = 41) was significantly worse than for 
      high PRA patients who had zero DR mismatches with their donors (100 and 78%, n = 
      20) (log-rank = 0.01 for DWFG not censored). Furthermore, the mean number of 
      HLA-A and -B mismatches was significantly greater in the high PRA/DR-mismatched 
      group (1.7 +/- 1.2, n = 41) compared with the high PRA/zero DR-mismatched group 
      (0.5 +/- 1.1, n = 19) (p < 0.001). Overall, these data suggest that the patient 
      who is highly sensitized to HLA Class I antigens has a long-term graft outcome 
      that is equivalent to less sensitized patients, but that HLA-DR mismatching and a 
      higher degree of Class I mismatching may be poor prognostic indicators in such 
      patients.
FAU - Bryan, C F
AU  - Bryan CF
AD  - Midwest Transplant Network, Westwood, KS 66205, USA.
FAU - Shield, C F
AU  - Shield CF
FAU - Pierce, G E
AU  - Pierce GE
FAU - Warady, B A
AU  - Warady BA
FAU - Aeder, M I
AU  - Aeder MI
FAU - Martinez, J
AU  - Martinez J
FAU - Luger, A M
AU  - Luger AM
FAU - Nelson, P W
AU  - Nelson PW
FAU - Ross, G
AU  - Ross G
FAU - Muruve, N
AU  - Muruve N
FAU - Mitchell, S I
AU  - Mitchell SI
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 0 (HLA-DR Antigens)
RN  - 0 (Histocompatibility Antigens Class I)
SB  - IM
MH  - Adult
MH  - Cadaver
MH  - Female
MH  - Graft Survival/immunology
MH  - HLA-DR Antigens/immunology
MH  - Histocompatibility Antigens Class I/*immunology
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Kidney Transplantation/*immunology
MH  - Male
EDAT- 2000/02/29 09:00
MHDA- 2000/03/11 09:00
CRDT- 2000/02/29 09:00
PHST- 2000/02/29 09:00 [pubmed]
PHST- 2000/03/11 09:00 [medline]
PHST- 2000/02/29 09:00 [entrez]
AID - 10.1034/j.1399-0012.2000.140115.x [doi]
PST - ppublish
SO  - Clin Transplant. 2000 Feb;14(1):79-84. doi: 10.1034/j.1399-0012.2000.140115.x.