PMID- 19584676
OWN - NLM
STAT- MEDLINE
DCOM- 20090723
LR  - 20090708
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 88
IP  - 1
DP  - 2009 Jul 15
TI  - A lifetime versus a graft life approach redefines the importance of HLA matching 
      in kidney transplant patients.
PG  - 23-9
LID - 10.1097/TP.0b013e3181a9ec89 [doi]
AB  - INTRODUCTION: Human leukocyte antigen (HLA) matching has been de-emphasized in 
      the allocation of renal allografts and further discounting is planned in the new 
      United Network of Organ Sharing kidney allocation model. An unforeseen 
      consequence of poorer matching could be increased sensitization for candidates 
      pursuing retransplantation. METHODS: We examined candidates listed in the United 
      States from 1988 to 2007 from the Scientific Renal Transplant Registry (SRTR) 
      database that were relisted after loss of a primary kidney transplant (n=15,980). 
      The primary outcome was change in panel reactive antibody (PRA) from prior to 
      recipient's initial transplant to the subsequent listing. Absolute change in PRA 
      levels were examined in general linear models and the likelihood of becoming 
      newly sensitized in logistic models. RESULTS: There was no appreciable change in 
      PRA for patients receiving a first 0 HLA-A, -B, -DR, or 0 HLA-A, -B-mismatched 
      kidney transplant; contrariwise, there was a significant increase in PRA by 
      increasing HLA mismatch of the first transplant. Only 10% of patients became 
      sensitized after a 0 HLA-A, -B-mismatched transplant, whereas the proportion rose 
      up to 37% with increasing HLA mismatches. Other factors, notably younger age and 
      African American race, also contributed to a higher PRA at relisting. 
      CONCLUSIONS: Although there might be a limited impact of HLA matching on acute 
      rejection and graft survival, many patients might be negatively impacted from 
      poor HLA matching of their first kidney transplant when needing a second 
      transplant. This might be particularly important in patients with a long life 
      expectancy because of the high likelihood of needing a second transplant during 
      their lifetime.
FAU - Meier-Kriesche, Herwig-Ulf
AU  - Meier-Kriesche HU
AD  - Department of Medicine, University of Florida, Gainesville, FL 32610, USA. 
      meierhu@medicine.ufl.edu
FAU - Scornik, Juan C
AU  - Scornik JC
FAU - Susskind, Brian
AU  - Susskind B
FAU - Rehman, Shehzad
AU  - Rehman S
FAU - Schold, Jesse D
AU  - Schold JD
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Graft Rejection/immunology/*prevention & control
MH  - Graft Survival/*immunology
MH  - HLA Antigens/*blood
MH  - *Histocompatibility
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Kidney Transplantation/*adverse effects
MH  - Least-Squares Analysis
MH  - *Life Expectancy
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Registries
MH  - Reoperation
MH  - Risk Assessment
MH  - Time Factors
MH  - Tissue and Organ Procurement
MH  - *Transplantation Tolerance
MH  - United States
MH  - Waiting Lists
MH  - Young Adult
EDAT- 2009/07/09 09:00
MHDA- 2009/07/25 09:00
CRDT- 2009/07/09 09:00
PHST- 2009/07/09 09:00 [entrez]
PHST- 2009/07/09 09:00 [pubmed]
PHST- 2009/07/25 09:00 [medline]
AID - 00007890-200907150-00005 [pii]
AID - 10.1097/TP.0b013e3181a9ec89 [doi]
PST - ppublish
SO  - Transplantation. 2009 Jul 15;88(1):23-9. doi: 10.1097/TP.0b013e3181a9ec89.