PMID- 17509448
OWN - NLM
STAT- MEDLINE
DCOM- 20070926
LR  - 20220311
IS  - 0198-8859 (Print)
IS  - 0198-8859 (Linking)
VI  - 68
IP  - 6
DP  - 2007 Jun
TI  - The impact of human leukocyte antigen matching on transplant complications and 
      immunosuppression dosage.
PG  - 491-9
AB  - Administrative claims data facilitate ascertainment of outcomes not collected by 
      the transplant registry and provide the opportunity to examine prescribed doses 
      of immunosuppressive medications. Here, we examine the impact of human leukocyte 
      antigen (HLA) matching on traditional outcomes, rejection and survival, and use 
      novel methods to examine immunosuppresion doses and complication rates. The 
      central hypothesis tested in this analysis is that HLA-matched recipients receive 
      lower doses of immunosuppression and have fewer posttransplant complications. We 
      break from tradition by examining HLA matching in both living and deceased donor 
      kidney transplants. As secondary aims, we compare the relative impact of class I 
      and II mismatches and describe outcomes achieved with older donors. Medicare 
      claims linked to the United States Renal Data System database for 23,443 kidney 
      transplants were included in the study. A total of 15,793 transplants were DR 
      mismatched (DRMM), 5,340 manifested no DR mismatches (NODRMM), and 2,310 
      manifested no ABDR mismatches (NOABDRMM). Patients with NOABDRMM experienced 
      lower adjusted risk of rejection (0.66, 95% confidence interval 0.59-0.74, P < 
      0.001) and lower hazard of graft loss (0.69, 0.61-0.77, P < 0.001) and death 
      (0.76, 0.63-0.92, P < 0.001) compared with those with DRMM. The hazard of cardiac 
      and diabetic complications was similar between recipients of NOADRMM and DRMM 
      transplants, but the hazard of diarrhea was significantly lower (0.82, 0.73-0.92, 
      P < 0.001) in patients with NOABDRMM. The 6-month dose of mycophenolate mofetil 
      was lower in patients with NOABDRMM. This study validates previous studies that 
      indicated significantly lower risks of rejection, graft loss, and death among 
      patients with 0 HLA-A,B,DR mismatches. Use of administrative claims revealed 
      similar rates of cardiovascular complications. However, HLA-matched deceased 
      donor recipients received lower dosages of mycophenolate mofetil and manifested a 
      lower risk of developing posttransplant diarrhea.
FAU - Aydingoz, Selda Emre
AU  - Aydingoz SE
AD  - Center for Outcomes Research, Department of Internal Medicine, Saint Louis 
      University, Saint Louis, MO 63104, USA.
FAU - Takemoto, Steven K
AU  - Takemoto SK
FAU - Pinsky, Brett W
AU  - Pinsky BW
FAU - Salvalaggio, Paolo R
AU  - Salvalaggio PR
FAU - Lentine, Krista L
AU  - Lentine KL
FAU - Willoughby, Lisa
AU  - Willoughby L
FAU - Hoover, Beverly
AU  - Hoover B
FAU - Burroughs, Thomas A
AU  - Burroughs TA
FAU - Schnitzler, Mark A
AU  - Schnitzler MA
FAU - Graff, Ralph
AU  - Graff R
LA  - eng
PT  - Journal Article
DEP - 20070315
PL  - United States
TA  - Hum Immunol
JT  - Human immunology
JID - 8010936
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Graft Rejection/epidemiology
MH  - Graft Survival
MH  - HLA-A Antigens/*analysis/immunology
MH  - HLA-B Antigens/*analysis
MH  - HLA-DR Antigens/*analysis
MH  - Histocompatibility Testing
MH  - Humans
MH  - *Immunosuppression Therapy
MH  - Multivariate Analysis
MH  - Registries/statistics & numerical data
MH  - Tissue Donors
MH  - Transplants/*adverse effects
EDAT- 2007/05/19 09:00
MHDA- 2007/09/27 09:00
CRDT- 2007/05/19 09:00
PHST- 2006/11/15 00:00 [received]
PHST- 2007/02/07 00:00 [revised]
PHST- 2007/02/13 00:00 [accepted]
PHST- 2007/05/19 09:00 [pubmed]
PHST- 2007/09/27 09:00 [medline]
PHST- 2007/05/19 09:00 [entrez]
AID - S0198-8859(07)00041-9 [pii]
AID - 10.1016/j.humimm.2007.02.004 [doi]
PST - ppublish
SO  - Hum Immunol. 2007 Jun;68(6):491-9. doi: 10.1016/j.humimm.2007.02.004. Epub 2007 
      Mar 15.