PMID- 12640315
OWN - NLM
STAT- MEDLINE
DCOM- 20030410
LR  - 20061115
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 75
IP  - 5
DP  - 2003 Mar 15
TI  - Human leukocyte antigens DR and AB and kidney retransplantation.
PG  - 718-23
AB  - BACKGROUND: Although class II human leukocyte antigen (HLA) DR mismatching has 
      been shown to demonstrate a significant effect on kidney regraft survival, it has 
      not generally been clinically emphasized. METHODS: We examined 2,574 kidney 
      retransplants performed in Southeastern Organ Procurement Foundation centers 
      between January 1988 and December 1997 in which there was ABDR typing on both 
      donor and recipient and pretransplant panel reactive antibody (PRA) data. 
      RESULTS: Cox regression of multiple variables demonstrated that the most 
      important risk factors in descending order were DR mismatching, non-white 
      recipient, female donor, PRA as a continuous variable, and cold ischemia time. 
      Although DR mismatching demonstrated a significant effect in white recipients, 
      the impact was much greater in non-white recipients. In both groups, zero to four 
      AB mismatches demonstrated no significant effect on regraft survival if DR was 
      matched and only a minimal effect when DR was mismatched. The discrepancy of 
      these findings with reports that demonstrate a stepwise decrease in regraft 
      survival on the basis of the total zero to six ABDR mismatches was explained by 
      the fact that the zero to six ABDR mismatches are a combination of AB mismatches 
      with little effect and DR mismatches with a major effect. Regraft survival 
      decreased progressively in association with increasing PRA. CONCLUSIONS: DR 
      matching is critically important in kidney retransplantation. There was no 
      significant difference in survival of zero ABDR mismatched retransplants compared 
      with one to four AB and zero DR mismatched retransplants. On the other hand, 
      kidney graft survival of all one to four AB and zero DR mismatches exceeded that 
      of one or two DR mismatched retransplants. We propose that the association of 
      decreasing regraft survival with increasing PRA reflects undetected sensitization 
      to class II, and possibly class I, antigens.
FAU - Thompson, John S
AU  - Thompson JS
AD  - Department of Medicine, VAMC/University of Kentucky Medical Center, Lexington, 
      KY, USA. jsthom1@vky.edu
FAU - Thacker, Leroy R 2nd
AU  - Thacker LR 2nd
FAU - Krishnan, Gopal
AU  - Krishnan G
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Female
MH  - Graft Survival
MH  - HLA-A Antigens/*analysis
MH  - HLA-B Antigens/*analysis
MH  - HLA-DR Antigens/*analysis
MH  - Histocompatibility Testing
MH  - Humans
MH  - Kidney Transplantation/*immunology
MH  - Male
MH  - Reoperation
MH  - Time Factors
EDAT- 2003/03/18 04:00
MHDA- 2003/04/11 05:00
CRDT- 2003/03/18 04:00
PHST- 2003/03/18 04:00 [pubmed]
PHST- 2003/04/11 05:00 [medline]
PHST- 2003/03/18 04:00 [entrez]
AID - 10.1097/01.TP.0000048376.79803.C1 [doi]
PST - ppublish
SO  - Transplantation. 2003 Mar 15;75(5):718-23. doi: 
      10.1097/01.TP.0000048376.79803.C1.