title: The effect of HLA mismatch on highly sensitized renal allograft recipients.
abstract: BACKGROUND
  We examined the effects of increasing human leukocyte antigen (HLA) mismatches (MM) on long-term graft outcomes in patients transplanted with a panel reactive antibody (PRA) >80% over a 10-yr period.
  
  
  METHODS
  A total of 142 recipients were divided into three groups based on the number of HLA MM with their allograft (0-2, 3-4 and 5-6 MM; Groups I, II and III). All patients received the same immunosuppression protocol.
  
  
  RESULTS
  The higher MM groups had a higher incidence of rejection (4.4% vs. 11.4% vs. 31.3%, p < 0.01). A multivariate analysis showed that rejection was the only significant variable affecting graft loss (OR = 7.45, p = 0.01). There was a trend toward more CMV infection and worse graft function with higher MM. Kaplan-Meier five-yr graft survival estimates were 100% vs. 81% vs. 74% for Groups I, II and III, respectively (p = 0.14).
  
  
  CONCLUSIONS
  In patients with PRA levels >80%, a higher HLA MM is associated with higher incidence of acute rejection. Acute rejection was the only significant variable affecting graft loss. We found a trend toward more CMV infections and worse graft outcomes with higher MM. Closer HLA matching and immunologic monitoring needs to be considered to improve graft outcomes among sensitized recipients.
authors.affiliation: Tulane Abdominal Transplant Institute, Tulane University School of Medicine, New Orleans, LA, USA. aparames@tulane.edu
authors.forename: Anil S
authors.initials: AS
authors.lastname: Paramesh
authors.forename: Rubin
authors.initials: R
authors.lastname: Zhang
authors.forename: John
authors.initials: J
authors.lastname: Baber
authors.forename: C L
authors.initials: CL
authors.lastname: Yau
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Slakey
authors.forename: Mary T
authors.initials: MT
authors.lastname: Killackey
authors.forename: Qing
authors.initials: Q
authors.lastname: Ren
authors.forename: Karen
authors.initials: K
authors.lastname: Sullivan
authors.forename: Jean
authors.initials: J
authors.lastname: Heneghan
authors.forename: Sander S
authors.initials: SS
authors.lastname: Florman
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000276:immunology*
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies