Long-term results of living kidney transplantation from HLA-identical sibling donors under calcineurin inhibitor immunosuppression.
BACKGROUND
Recently, it has been revealed that alloantigen-independent causes are important factors for late graft loss in kidney transplantation. We compared the results of living kidney transplantation from HLA-identical siblings with those from HLA-non-identical siblings to analyse the impact of alloantigen-independent factors on long-term graft survival.


METHODS
Two hundred and sixty-six recipients who were grafted from their siblings between 1983 and 2002 were subdivided into those transplanted from HLA-identical donors (n=86) and those from HLA-non-identical donors (n=180).


RESULTS
The incidence of acute rejection was significantly lower in the HLA-identical group than in the HLA-non-identical group (9.3% vs 53.9%, respectively; P<0.0001). Graft survival was significantly higher in the HLA-identical group than in the HLA-non-identical group (91.3% vs 79.2% at 5 years, 80.3% vs 66.8% at 10 years and 59.1% vs 51.7% at 15 years, respectively; P=0.0372). Although acute rejection was not seen as a cause of graft loss in the HLA-identical group, death with functioning graft, recurrence of the original disease or chronic allograft nephropathy were observed as the major causes of graft loss in the late period of the HLA-identical group.


CONCLUSIONS
We concluded that alloantigen-independent causes constitute a crucial factor for graft loss in the late period of HLA-identical kidney transplantation.
Shimmura
Hiroaki
H
Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan. shimmura@kc.twmu.ac.jp
Tanabe
Kazunari
K
Ishida
Hideki
H
Miyamoto
Naoshi
N
Tokumoto
Tadahiko
T
Ishikawa
Nobuo
N
Toma
Hiroshi
H
D000328:Adult; D019703:Calcineurin / Q000378:metabolism; D065095:Calcineurin Inhibitors; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D035781:Siblings; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome
D065095:Calcineurin Inhibitors; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D019703:Calcineurin