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Successful cadaveric renal transplantation of patients highly sensitized to HLA Class I antigens
Author(s) -
Bryan Cf,
Shield Cf,
Pierce Ge,
Warady Ba,
Aeder Mi,
Martinez J,
Luger Am,
Nelson Pw,
Ross G,
Muruve N,
Mitchell Si
Publication year - 2000
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1034/j.1399-0012.2000.140115.x
Subject(s) - medicine , panel reactive antibody , human leukocyte antigen , cadaveric spasm , transplantation , histocompatibility , antigen , kidney transplantation , surgery , urology , immunology , gastroenterology
The purpose of our investigation was to evaluate long‐term graft survival and the role of histocompatibility in patients who were highly sensitized to human leukocyte antigen (HLA) Class I antigens and received a cadaveric renal transplant. Our multi‐institutional study evaluated 7‐yr graft outcomes and the histocompatibility requirements of 61 (6.1%) highly sensitized (anti‐human globulin panel reactive antibody [AHG PRA], ≥80%) cadaveric renal transplantation patients, transplanted between 1988 and 1997, among 999 consecutive cadaveric renal transplants.One‐ and 7‐yr graft survival in the high PRA group (n=61) was 76 and 59%, and was not significantly different from that in the low PRA group (n=938), 86 and 59% (Wilcoxon=0.11; log‐rank=0.45) (died with a functioning graft [DWFG] not censored). When those data were divided into primary and regrafts, 1‐ and 7‐yr graft outcomes for high and low PRA groups were not significantly different [(primary, 1‐ and 7‐yr survival: high PRA=83 and 74%, n=30, and low PRA=87 and 61%, n=825; log‐rank=0.37 for DWFG not censored) (regrafts, 1‐ and 7‐yr survival: high PRA=70 and 42%, n=31, and low PRA=80 and 43%, n=113; log‐rank=0.36 for DWFG not censored)]. We did observe a subgroup of the high PRA patient group that had inferior graft outcomes. Graft outcome at 1 and 6 yr in the high PRA group for patients who had one to two DR mismatches (65 and 50%, n=41) was significantly worse than for high PRA patients who had zero DR mismatches with their donors (100 and 78%, n=20) (log‐rank=0.01 for DWFG not censored). Furthermore, the mean number of HLA‐A and ‐B mismatches was significantly greater in the high PRA/DR‐mismatched group (1.7±1.2, n=41) compared with the high PRA/zero DR‐mismatched group (0.5±1.1, n=19) (p<0.001). Overall, these data suggest that the patient who is highly sensitized to HLA Class I antigens has a long‐term graft outcome that is equivalent to less sensitized patients, but that HLA‐DR mismatching and a higher degree of Class I mismatching may be poor prognostic indicators in such patients.