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Impact of repeat human leukocyte antigen mismatches on kidney graft survival: a contemporary Collaborative Transplant Study analysis

Repeat human leukocyte antigen (HLA) mismatches (RMM) have been historically associated with an increased risk of graft loss after repeat kidney transplantation, in particular HLA-DR RMM in sensitized recipients. As routine use of sensitive assays can at present prevent the transplantation of RMM in...

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Main Authors: Pipeleers, Lissa (Author) , Unterrainer, Christian (Author) , Emonds, Marie-Paule (Author) , Wissing, Karl Martin (Author) , Tran, Thuong Hien (Author)
Format: Article (Journal)
Language:English
Published: July 2025
In: American journal of transplantation
Year: 2025, Volume: 25, Issue: 7, Pages: 1481-1490
ISSN:1600-6143
DOI:10.1016/j.ajt.2024.12.014
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ajt.2024.12.014
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1600613524007901
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Author Notes:Lissa Pipeleers, Christian Unterrainer, Marie-Paule Emonds, Karl Martin Wissing, Thuong Hien Tran
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Summary:Repeat human leukocyte antigen (HLA) mismatches (RMM) have been historically associated with an increased risk of graft loss after repeat kidney transplantation, in particular HLA-DR RMM in sensitized recipients. As routine use of sensitive assays can at present prevent the transplantation of RMM in hosts with donor-specific antibodies, we hypothesized that RMM would no longer be associated with graft loss. We performed a registry analysis of the Collaborative Transplant Study database including 6711 patients who received a second kidney transplant (KT) between 2010 and 2021, with at least 1 HLA-A, HLA-B, or HLA-DR mismatch. No increased risk for graft loss was observed for the second KT with a class I RMM, regardless of sensitization status. For the second KT with a HLA-DR RMM, the hazard ratio for graft loss in the first year after transplantation was 1.61 (95% CI 1.16-2.23; P = .004) compared to recipients without an RMM and increased to 2.21 (95% CI 1.24-3.63: P = .002) in sensitized recipients (latest complement-dependent cytotoxicity panel reactive antibodies >0%). Our observations suggest that class I RMM do not need to be systematically avoided. In contrast, HLA-DR RMM still had a negative impact on graft survival in this contemporary cohort, despite the widespread availability of Luminex.
Item Description:Online verfügbar: 22. Dezember 2024, Artikelversion: 30. Juni 2025
Gesehen am 19.11.2025
Physical Description:Online Resource
ISSN:1600-6143
DOI:10.1016/j.ajt.2024.12.014

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