PMID- 21693232
OWN - NLM
STAT- MEDLINE
DCOM- 20111014
LR  - 20221207
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 43
IP  - 5
DP  - 2011 Jun
TI  - Impact of human leukocyte antigen-DR mismatch status on kidney graft survival in 
      a predominantly African-American population under the newer immunosuppressive 
      era.
PG  - 1544-50
LID - 10.1016/j.transproceed.2011.01.169 [doi]
AB  - BACKGROUND: Human leukocyte antigen (HLA)-DR has been shown to be immunogenic and 
      associated with poor long-term graft function. However, under potent induction 
      immunosuppression with antithymocyte globulin, the impact of the HLA-DR remains 
      unclear. METHOD: We reviewed 672 renal transplant recipients who received their 
      transplants between 1998 and 2007. All patients received antithymocyte globulin 
      as induction therapy followed by tacrolimus + prednisone + mycophenolate mofetil 
      for maintenance immunosuppression. We divided the patients into three groups 
      according to HLA-DR mismatch status (zero, one, or two mismatches). RESULTS: The 
      three groups were different in total number of mismatches, deceased donor 
      transplant, and delayed graft function, respectively. By Kaplan-Meier survival 
      analysis, actuarial graft survival was significantly lower in the HLA-DR two 
      mismatches group (72%) compared to HLA-DR zero mismatches group (78.5%) or HLA-DR 
      one mismatch group (78.5%; P = .05, by log-rank test). Using Cox regression 
      analysis, the risk of graft failure with two HLA-DR mismatches as compared with 
      zero HLA-DR mismatches was 1.6 (95% confidence interval = 1.0-2.44, P = .049). 
      When adjusted for age, wait time, race, type of transplant, retransplant status, 
      T-cell flow crossmatch, delayed graft function, acute rejection, HLA-A and HLA-B, 
      the effect of HLA-DR on survival was not significant (P = .55). CONCLUSION: The 
      independent effect of HLA-DR mismatches on adverse graft survival is diminished 
      under potent antibody induction and maintenance immunosuppression in our 
      predominantly African-American population.
CI  - Copyright (c) 2011 Elsevier Inc. All rights reserved.
FAU - Karabicak, I
AU  - Karabicak I
AD  - Division of Transplantation, Department of Surgery, SUNY Downstate Medical 
      Center, Brooklyn, New York 11203, USA.
FAU - Adekile, A
AU  - Adekile A
FAU - Distant, D A
AU  - Distant DA
FAU - O'Shaunessy, D
AU  - O'Shaunessy D
FAU - Lewis, S
AU  - Lewis S
FAU - Sumrani, N B
AU  - Sumrani NB
FAU - Norin, A J
AU  - Norin AJ
FAU - Salifu, M O
AU  - Salifu MO
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (HLA-DR Antigens)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Aged
MH  - *Black People
MH  - Female
MH  - Graft Survival/*immunology
MH  - HLA-DR Antigens/*immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/*administration & dosage
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - United States
EDAT- 2011/06/23 06:00
MHDA- 2011/10/15 06:00
CRDT- 2011/06/23 06:00
PHST- 2010/07/06 00:00 [received]
PHST- 2010/09/23 00:00 [revised]
PHST- 2011/01/18 00:00 [accepted]
PHST- 2011/06/23 06:00 [entrez]
PHST- 2011/06/23 06:00 [pubmed]
PHST- 2011/10/15 06:00 [medline]
AID - S0041-1345(11)00263-6 [pii]
AID - 10.1016/j.transproceed.2011.01.169 [doi]
PST - ppublish
SO  - Transplant Proc. 2011 Jun;43(5):1544-50. doi: 10.1016/j.transproceed.2011.01.169.