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Long‐term impact of human leukocyte antigen mismatches combined with expanded criteria donor on allograft outcomes in deceased donor kidney transplantation
Author(s) -
Shin Sung,
Kim Young Hoon,
Choi Byung Hyun,
Choi Ji Yoon,
Jung Joo Hee,
Cho Han Kyung,
Han Duck Jong
Publication year - 2015
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 - 10.1111/ctr.12487
Subject(s) - medicine , hazard ratio , human leukocyte antigen , kidney transplantation , proportional hazards model , confidence interval , transplantation , biopsy , histocompatibility testing , gastroenterology , immunology , surgery , antigen
The long‐term impact of human leukocyte antigen ( HLA ) mismatches combined with expanded criteria donors ( ECD ) on clinical outcomes has not been fully evaluated in recipients of deceased donor ( DD ) kidney transplantations. Of 595 DD renal transplant recipients in our center between 1991 and 2011, 210 recipients (36%) had 0–3 HLA mismatches/standard criteria donor ( SCD ), 353 (59%) had 4–6 HLA mismatches/ SCD or 0–3 HLA mismatches/ ECD , and 32 (5%) had 4–6 HLA mismatches/ ECD . The mortality rate was significantly highest in the patients with 4–6 HLA mismatches/ ECD (p = 0.040). The most common cause of death in this group was infection (50%). There were no significant differences in overall graft survival and death‐censored graft survival. The biopsy‐proven acute rejection rate was significantly higher in the 4–6 HLA mismatches/ ECD group (p = 0.011). Cox‐regression multivariate analyses showed that 4–6 HLA mismatches plus ECD (adjusted hazard ratio [ AHR ], 3.2; 95% confidence interval [ CI ], 1.17–10.56) and diabetes ( AHR , 4.3; 95% CI , 1.50–12.28) were significant predictors of recipient mortality. In conclusion, ≥4 HLA mismatches plus ECD were associated with significantly higher rates of biopsy‐proven acute rejection and mortality compared with other groups undergoing DD kidney transplantation.