PMID- 21289594
OWN - NLM
STAT- MEDLINE
DCOM- 20110601
LR  - 20110325
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 91
IP  - 7
DP  - 2011 Apr 15
TI  - Effect of immunosuppression for first kidney or kidney/pancreas transplant on 
      sensitization at the time of second transplant.
PG  - 751-6
LID - 10.1097/TP.0b013e31820cfd5b [doi]
AB  - BACKGROUND: Previously transplanted patients are more likely to be sensitized, 
      leading to prolonged waitlist times and decreased graft survival. This analysis 
      of the United Network for Organ Sharing kidney/pancreas transplant database 
      investigates factors at the time of first transplant associated with increased 
      sensitization in patients undergoing second transplantation. METHODS: Records of 
      nonsensitized patients (panel reactive antibodies [PRA] <20%) receiving a primary 
      transplant in 1999 or later were analyzed to determine whether immunosuppressive 
      agents at the time of first transplant were associated with a change in PRA from 
      first to second transplant. Variables included gender, race, human leukocyte 
      antigen (HLA) mismatch, rabbit antithymocyte globulin (RATG), interleukin-2 
      receptor antagonists, tacrolimus (FK), cyclosporine A (CSA), and mycophenolate 
      mofetil/sodium (MMF). RESULTS: For the primary endpoint of increase in PRA 
      greater than or equal to 20%, African Americans (AA) versus non-AA (OR 2.63, 
      P<0.0001) and HLA nonzero mismatch versus zero mismatch (OR 2.90, P<0.0001) were 
      associated with increased sensitization. The effect of immunosuppressive regimen 
      depended on race and HLA status. In non-AAs/HLA mismatch (1-6), interleukin-2 
      receptor antagonists versus RATG (OR 1.40, P=0.001), CSA versus FK (OR 1.69, 
      P<0.001) and no MMF versus MMF (OR 1.39, P<0.001) were also associated with 
      increased sensitization. In AAs/HLA mismatch (1-6), no induction versus RATG (OR 
      1.59, P=0.031) and CSA versus FK (OR 1.68, P=0.006) were associated with 
      increased sensitization. CONCLUSIONS: These data suggest a reduced risk of 
      sensitization at the time of second transplant when using more potent 
      immunosuppression with RATG, FK, and MMF for nonsensitized primary kidney or 
      kidney/pancreas transplant patients. These effects seem to be related to race and 
      HLA mismatch.
FAU - Dawson, Kyle L
AU  - Dawson KL
AD  - Department of Pharmacy, The Methodist Hospital, Houston, TX. 2Center for 
      Biostatistics, The Methodist Hospital Research Institute, Houston, TX 77030, USA. 
      KLDawson@tmhs.org
FAU - Patel, Samir J
AU  - Patel SJ
FAU - Xu, Jiaqiong
AU  - Xu J
FAU - Knight, Richard J
AU  - Knight RJ
FAU - Gaber, A Osama
AU  - Gaber AO
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Receptors, Interleukin-2)
SB  - IM
MH  - Adult
MH  - Antilymphocyte Serum/pharmacology
MH  - Female
MH  - Graft Survival
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/*pharmacology
MH  - Kidney Transplantation/*immunology
MH  - Male
MH  - Middle Aged
MH  - Pancreas Transplantation/*immunology
MH  - Receptors, Interleukin-2/antagonists & inhibitors
MH  - Transplantation, Homologous
EDAT- 2011/02/04 06:00
MHDA- 2011/06/02 06:00
CRDT- 2011/02/04 06:00
PHST- 2011/02/04 06:00 [entrez]
PHST- 2011/02/04 06:00 [pubmed]
PHST- 2011/06/02 06:00 [medline]
AID - 10.1097/TP.0b013e31820cfd5b [doi]
PST - ppublish
SO  - Transplantation. 2011 Apr 15;91(7):751-6. doi: 10.1097/TP.0b013e31820cfd5b.