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HLA‐A incompatibility associated with enhanced long‐term renal graft survival in HLA‐B, DR mismatched transplants
Author(s) -
BUĆIN D.,
EKBERG H.,
LINDHOLM A.,
PERSSON H.,
TUFVESON G.,
ALBRECHTSEN D.
Publication year - 1994
Publication title -
immunology and cell biology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.999
H-Index - 104
eISSN - 1440-1711
pISSN - 0818-9641
DOI - 10.1038/icb.1994.69
Subject(s) - medicine , human leukocyte antigen , immunosuppression , transplantation , prednisolone , kidney , histocompatibility , survival rate , kidney transplantation , hla a , gastroenterology , surgery , immunology , antigen
Summary The effect of HLA‐A matching on long‐term cadaver kidney graft survival was analysed, on average, 6 years after transplantation in a total of 1085 cyclosporine (CyA)‐treated patients. A beneficial effect of HLA‐A mismatching on graft survival was found by univariate and multivariate analyses ( P < 0.05). Enhanced graft survival was associated with HLA‐A mismatching in transplants mismatched for HLA‐B,DR ( P = 0.03), but not in HLA‐B,DR compatible transplants. High 6 year graft survival rates, 78% and 66%, were found in transplants mismatched for two or one HLA‐A antigens, respectively, among patients without any acute rejection episode. This was significantly higher than the survival rate of 55% found in HLA‐A compatible transplants ( P = 0.001). In patients who had suffered from acute rejection episodes, a prolonged graft survival was also associated with HLA‐A mismatching in HLA‐B,DR mismatched transplants ( P = 0.04). The beneficial effect on graft survival of HLA‐A mismatching was most pronounced in patients treated with high/medium dose CyA and prednisolone ( P =0.004 overall and P = 0.0007 for HLA‐B,DR mismatched transplants). In conclusion, HLA‐A mismatching was associated with enhanced long‐term renal graft survival in CyA‐treated recipients of HLA‐B,DR mismatched transplants. In clinical situations, the present results might, if confirmed, contribute to the prolongation of long‐term graft survival. The results might indicate the existence of tolerance promoting allogeneic markers within the HLA‐A class I region.