Multivariate analysis of the effectiveness of using antibody induction therapy according to the degree of HLA mismatches.
OBJECTIVE
HLA mismatches have a strong impact on acute rejection and renal allograft survival. The objective of this study was to evaluate the effectiveness of antibody induction according to the degree of HLA mismatches.


METHODS
Of 20,429 deceased donor (DD) transplantations and 12,859 living donor (LD) transplantations reported to the United Network for Organ Sharing (UNOS) between 1999 and 2001, 51% of DD and 45% of LD transplant recipients received induction therapy. Propensity scores (PS) were calculated to indicate independent factors associated with the use of induction. Levels of HLA match examined for DD transplant recipients were 0 ABDR (n = 3239), 0 DR (n = 4210), and DR mismatched transplants (n = 12,980), and 0 (n = 1133), 1 (n = 3836), and 2 (n = 7890) haplotype mismatches for LD transplant recipients. Outcome parameters were reported as hazard ratios (HR) for graft loss and odds ratios (OR) for first-year acute rejection.


RESULTS
Recipients with HLA mismatches were more likely to receive induction antibody for DR mismatch in DDs (PS = 1.11, 95% confidence interval [CI] 1.04-1.19) and for haplotype mismatch in LDs (PS = 1.36, 95% CI 1.22-1.52). Induction reduced the likelihood of acute rejection for DD transplant recipients regardless of the level of HLA mismatch (OR = 0.70; 95% CI 0.57-0.85 in 0 ABDR MM; OR = 0.76, 95% CI 0.64-0.89 in 0 DR MM; and OR = 0.69, 95% CI 0.62-0.77 in DR MM), and for 2 haplotype mismatched LD transplant recipients (OR = 0.82, 95% CI 0.70-0.96); in other LD transplant recipients, reductions in acute rejection rates were observed but not statistically significant. Induction reduced the risk of graft loss for DR mismatched DD transplant recipients by about 12% (HR = 0.88; 95% CI 0.80-0.97).


CONCLUSIONS
Antibody induction resulted in a significant reduction of acute rejection and graft loss for patients with HLA mismatch.
Bunnapradist
S
S
Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. Bunnapradist@cshs.org
Hong
A
A
Lee
B
B
Takemoto
S K
SK
D000917:Antibody Formation; D002102:Cadaver; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016017:Odds Ratio; D012044:Regression Analysis; D014019:Tissue Donors; D017211:Treatment Failure
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid