PMID- 23478360
OWN - NLM
STAT- MEDLINE
DCOM- 20130719
LR  - 20211021
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 95
IP  - 10
DP  - 2013 May 27
TI  - The impact of human leukocyte antigen mismatching on sensitization rates and 
      subsequent retransplantation after first graft failure in pediatric renal 
      transplant recipients.
PG  - 1218-24
LID - 10.1097/TP.0b013e318288ca14 [doi]
AB  - BACKGROUND: U.S. allocation policies currently place less emphasis on human 
      leukocyte antigen (HLA) matching in pediatric kidney transplant candidates to 
      minimize dialysis time. The impact this may have on pediatric recipients after 
      graft failure has not been extensively examined. METHODS: Using the Scientific 
      Registry of Transplant Recipients database, we examined HLA sensitization after 
      graft loss and regraft survival of all pediatric primary kidney transplant 
      recipients younger than 18 years transplanted between 1990 and 2008, stratified 
      by HLA-DR mismatch (MM) of first and second kidney transplant. RESULTS: Of 11,916 
      pediatric primary kidney transplant recipients, 2704 were relisted after first 
      graft failure. 1847 received a retransplants, and 857 remained on the waiting 
      list. Mean % panel reactive antibody increased from 6% to 45% for retransplant 
      and from 8% to 76% for those on the waiting list. The degree of sensitization and 
      waiting time to retransplantation increased with DR MM at first kidney 
      transplantation. Two DR MM statuses at first transplant were associated with a 
      20% reduction in the hazard of receiving a retransplant (hazard ratio, 0.80 for 2 
      vs. 0-1 DR MM; P<0.001). Five-year retransplant graft survival was associated 
      with the number of HLA MM at first and second kidney transplant. Retransplant 
      graft survival was similar in the circumstance of a 0-1 DR MM living donor 
      following a deceased donor, and the converse. CONCLUSION: In pediatric 
      recipients, increasing number of initial HLA-DR MMs is associated with HLA 
      sensitization, longer waiting time, decreased rate of retransplant, and decreased 
      regraft survival. Consideration of DR matching at first transplant may mitigate 
      these risks.
FAU - Gralla, Jane
AU  - Gralla J
AD  - Department of Pediatrics, University of Colorado Denver, Denver, CO, USA. 
      Jane.Gralla@ucdenver.edu
FAU - Tong, Suhong
AU  - Tong S
FAU - Wiseman, Alexander C
AU  - Wiseman AC
LA  - eng
GR  - UL1 TR000154/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Graft Survival
MH  - HLA-DR Antigens/*immunology
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Infant
MH  - *Kidney Transplantation/adverse effects
MH  - Male
MH  - Reoperation
MH  - Waiting Lists
EDAT- 2013/03/13 06:00
MHDA- 2013/07/20 06:00
CRDT- 2013/03/13 06:00
PHST- 2013/03/13 06:00 [entrez]
PHST- 2013/03/13 06:00 [pubmed]
PHST- 2013/07/20 06:00 [medline]
AID - 10.1097/TP.0b013e318288ca14 [doi]
PST - ppublish
SO  - Transplantation. 2013 May 27;95(10):1218-24. doi: 10.1097/TP.0b013e318288ca14.