title: Effect of immunosuppression for first kidney or kidney/pancreas transplant on sensitization at the time of second transplant.
abstract: BACKGROUND
  Previously transplanted patients are more likely to be sensitized, leading to prolonged waitlist times and decreased graft survival. This analysis of the United Network for Organ Sharing kidney/pancreas transplant database investigates factors at the time of first transplant associated with increased sensitization in patients undergoing second transplantation.
  
  
  METHODS
  Records of nonsensitized patients (panel reactive antibodies [PRA] <20%) receiving a primary transplant in 1999 or later were analyzed to determine whether immunosuppressive agents at the time of first transplant were associated with a change in PRA from first to second transplant. Variables included gender, race, human leukocyte antigen (HLA) mismatch, rabbit antithymocyte globulin (RATG), interleukin-2 receptor antagonists, tacrolimus (FK), cyclosporine A (CSA), and mycophenolate mofetil/sodium (MMF).
  
  
  RESULTS
  For the primary endpoint of increase in PRA greater than or equal to 20%, African Americans (AA) versus non-AA (OR 2.63, P<0.0001) and HLA nonzero mismatch versus zero mismatch (OR 2.90, P<0.0001) were associated with increased sensitization. The effect of immunosuppressive regimen depended on race and HLA status. In non-AAs/HLA mismatch (1-6), interleukin-2 receptor antagonists versus RATG (OR 1.40, P=0.001), CSA versus FK (OR 1.69, P<0.001) and no MMF versus MMF (OR 1.39, P<0.001) were also associated with increased sensitization. In AAs/HLA mismatch (1-6), no induction versus RATG (OR 1.59, P=0.031) and CSA versus FK (OR 1.68, P=0.006) were associated with increased sensitization.
  
  
  CONCLUSIONS
  These data suggest a reduced risk of sensitization at the time of second transplant when using more potent immunosuppression with RATG, FK, and MMF for nonsensitized primary kidney or kidney/pancreas transplant patients. These effects seem to be related to race and HLA mismatch.
authors.affiliation: Department of Pharmacy, The Methodist Hospital, Houston, TX. 2Center for Biostatistics, The Methodist Hospital Research Institute, Houston, TX 77030, USA. KLDawson@tmhs.org
authors.forename: Kyle L
authors.initials: KL
authors.lastname: Dawson
authors.forename: Samir J
authors.initials: SJ
authors.lastname: Patel
authors.forename: Jiaqiong
authors.initials: J
authors.lastname: Xu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Knight
authors.forename: A Osama
authors.initials: AO
authors.lastname: Gaber
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000494:pharmacology; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology*; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors; D014184:Transplantation, Homologous
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2