PMID- 18322434
OWN - NLM
STAT- MEDLINE
DCOM- 20080328
LR  - 20080306
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 85
IP  - 3
DP  - 2008 Feb 15
TI  - HLA mismatches remain risk factors for acute kidney allograft rejection in 
      patients receiving quadruple immunosuppression with anti-interleukin-2 receptor 
      antibodies.
PG  - 411-6
LID - 10.1097/TP.0b013e31816349b5 [doi]
AB  - BACKGROUND: New immunosuppressive drugs such as anti-interleukin-2 receptor 
      antibodies (aIL2R) and mycophenolate mofetil (MMF) have reduced the incidence of 
      acute rejection after renal transplantation. Whether matching donor and recipient 
      human leukocyte antigen (HLA) antigens is still relevant in patients receiving 
      modern immunosuppression has been questioned. METHODS: We retrospectively 
      analyzed the incidence and risk factors of acute rejection during the first 
      posttransplant year and the impact of acute rejection on long-term graft survival 
      in a cohort of 208 renal transplant patients treated with aIL2R (basiliximab, 
      n=166; daclizumab, n=42), calcineurin inhibitors (tacrolimus, n=180; cyclosporin, 
      n=28), mycophenolate mofetil, and steroids. Graft and patient survival were 
      calculated by the Kaplan-Meier method. Risk factors for acute rejection were 
      analyzed by logistic regression modeling. RESULTS: Twenty-seven patients were 
      treated for acute rejection (26 biopsy-proven) during the first posttransplant 
      year. The Kaplan-Meier estimate of first-year acute rejection was 13.2%. The 
      number of HLA mismatches (odds ratio [OR] 1.65 per HLA mismatch) and long periods 
      of dialysis before transplantation (OR 3.1 for more than 4 years of dialysis) 
      were the only independent risk factors for first-year acute rejection. First-year 
      acute rejection was associated with a significant reduction in overall and 
      death-censored graft survival at 5 years after transplantation. CONCLUSIONS: 
      Although infrequent in patients receiving modern immunosuppressive drugs, acute 
      rejection remains an important risk factor for graft loss after renal 
      transplantation. Our results suggest that better HLA matching and shorter periods 
      of dialysis before transplantation could reduce acute rejection rates and further 
      improve outcomes under current immunosuppressive regimens.
FAU - Wissing, Karl M
AU  - Wissing KM
AD  - Department of Nephrology and Renal Transplantation, ULB Hopital Erasme, Brussels, 
      Belgium. wissing@ulb.ac.be
FAU - Fomegne, Guy
AU  - Fomegne G
FAU - Broeders, Nilufer
AU  - Broeders N
FAU - Ghisdal, Lidia
AU  - Ghisdal L
FAU - Hoang, Anh Dung
AU  - Hoang AD
FAU - Mikhalski, Dimitri
AU  - Mikhalski D
FAU - Donckier, Vincent
AU  - Donckier V
FAU - Vereerstraeten, Pierre
AU  - Vereerstraeten P
FAU - Abramowicz, Daniel
AU  - Abramowicz D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Receptors, Interleukin-2)
SB  - IM
CIN - Transplantation. 2008 Feb 15;85(3):312-3. PMID: 18301325
MH  - Acute Disease
MH  - Antibodies/*immunology/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Graft Rejection/*immunology
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Receptors, Interleukin-2/*immunology
MH  - Risk Factors
MH  - Transplantation, Homologous/immunology
EDAT- 2008/03/07 09:00
MHDA- 2008/03/29 09:00
CRDT- 2008/03/07 09:00
PHST- 2008/03/07 09:00 [pubmed]
PHST- 2008/03/29 09:00 [medline]
PHST- 2008/03/07 09:00 [entrez]
AID - 00007890-200802150-00017 [pii]
AID - 10.1097/TP.0b013e31816349b5 [doi]
PST - ppublish
SO  - Transplantation. 2008 Feb 15;85(3):411-6. doi: 10.1097/TP.0b013e31816349b5.