PMID- 22483448
OWN - NLM
STAT- MEDLINE
DCOM- 20120730
LR  - 20120409
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 44
IP  - 3
DP  - 2012 Apr
TI  - The effect of recurrent glomerulonephritis and acute rejection episodes in zero 
      human leukocyte antigen-mismatched kidney transplantation.
PG  - 600-6
LID - 10.1016/j.transproceed.2011.11.042 [doi]
AB  - BACKGROUND: Although human leukocyte antigen (HLA)-identical renal 
      transplantation achieves superior graft outcomes, it does not uniformly allow 
      indefinite graft survival. Recurrence of the original disease and effects of 
      acute rejection episodes (ARE) may preclude indefinite survival. Herein, we have 
      analyzed the factors that affect the graft outcomes among HLA zero-mismatch 
      cases. METHODS: We performed a retrospective, single-center study to evaluate the 
      effect of recurrent glomerulonephritis (GN) and ARE on outcomes of grafts with 
      zero HLA-mismatches (n = 122) versus three to four mismatches (n = 317), and five 
      to six mismatches (n = 102). Forty-one percent of patients had GN as underlying 
      disease. RESULTS: Overall graft survival was 92.4% at 5 years and 79.6% at 10 
      years. HLA incompatibility did not affect graft survival: zero versus three to 
      four versus five to six mismatches = 92.8% versus 90.8% versus 95.8% at 5 years 
      and 82.5% versus 74.3% versus 85.1% at 10 years, respectively (P = .399). 
      Subgroup analysis for subjects with GN revealed that ARE (P = .001) and recurrent 
      GN (P = .003) were the risk factors for graft loss, whereas living donation was 
      protective (P = .029). ARE was more prevalent with greater HLA incompatibility [0 
      (reference) < three to four < five to six mismatches; P = .047 and P = .014]. 
      However, recurrent GN showed the opposite trend [0 (reference) > three to four > 
      five to six mismatches; P = .106 and P = .022]. Furthermore, graft loss due to 
      recurrent GN was significant among the HLA zero versus the three- to 
      four-mismatch group (P = .047). CONCLUSIONS: Graft survival was not affected by 
      the degree of HLA incompatibility, which was mainly due to the recurrence of 
      underlying disease. Therefore, a main focus should be the management of 
      recurrence, especially among HLA-identical kidney transplantations.
CI  - Copyright (c) 2012 Elsevier Inc. All rights reserved.
FAU - Jeon, H J
AU  - Jeon HJ
AD  - Department of Internal Medicine, Seoul National University Hospital, Seoul, 
      Korea.
FAU - Kim, Y S
AU  - Kim YS
FAU - Lee, S M
AU  - Lee SM
FAU - Ahn, C
AU  - Ahn C
FAU - Ha, J
AU  - Ha J
FAU - Kim, S J
AU  - Kim SJ
FAU - Kim, D K
AU  - Kim DK
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Glomerulonephritis/immunology/*surgery
MH  - *Graft Rejection
MH  - Graft Survival
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - Recurrence
MH  - Retrospective Studies
EDAT- 2012/04/10 06:00
MHDA- 2012/07/31 06:00
CRDT- 2012/04/10 06:00
PHST- 2012/04/10 06:00 [entrez]
PHST- 2012/04/10 06:00 [pubmed]
PHST- 2012/07/31 06:00 [medline]
AID - S0041-1345(11)01639-3 [pii]
AID - 10.1016/j.transproceed.2011.11.042 [doi]
PST - ppublish
SO  - Transplant Proc. 2012 Apr;44(3):600-6. doi: 10.1016/j.transproceed.2011.11.042.