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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| Hauptverfasser: | , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
July 2025
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| In: |
American journal of transplantation
Year: 2025, Jahrgang: 25, Heft: 7, Pages: 1481-1490 |
| ISSN: | 1600-6143 |
| DOI: | 10.1016/j.ajt.2024.12.014 |
| Online-Zugang: | 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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| Verfasserangaben: | Lissa Pipeleers, Christian Unterrainer, Marie-Paule Emonds, Karl Martin Wissing, Thuong Hien Tran |
MARC
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| 520 | |a 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. | ||
| 650 | 4 | |a anti-HLA antibodies | |
| 650 | 4 | |a graft survival | |
| 650 | 4 | |a HLA-mismatches | |
| 650 | 4 | |a kidney transplantation | |
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| 650 | 4 | |a repeat transplantation | |
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