title: Impact of human leukocyte antigen-DR mismatch status on kidney graft survival in a predominantly African-American population under the newer immunosuppressive era.
abstract: BACKGROUND
  Human leukocyte antigen (HLA)-DR has been shown to be immunogenic and associated with poor long-term graft function. However, under potent induction immunosuppression with antithymocyte globulin, the impact of the HLA-DR remains unclear.
  
  
  METHODS
  We reviewed 672 renal transplant recipients who received their transplants between 1998 and 2007. All patients received antithymocyte globulin as induction therapy followed by tacrolimus + prednisone + mycophenolate mofetil for maintenance immunosuppression. We divided the patients into three groups according to HLA-DR mismatch status (zero, one, or two mismatches).
  
  
  RESULTS
  The three groups were different in total number of mismatches, deceased donor transplant, and delayed graft function, respectively. By Kaplan-Meier survival analysis, actuarial graft survival was significantly lower in the HLA-DR two mismatches group (72%) compared to HLA-DR zero mismatches group (78.5%) or HLA-DR one mismatch group (78.5%; P = .05, by log-rank test). Using Cox regression analysis, the risk of graft failure with two HLA-DR mismatches as compared with zero HLA-DR mismatches was 1.6 (95% confidence interval = 1.0-2.44, P = .049). When adjusted for age, wait time, race, type of transplant, retransplant status, T-cell flow crossmatch, delayed graft function, acute rejection, HLA-A and HLA-B, the effect of HLA-DR on survival was not significant (P = .55).
  
  
  CONCLUSIONS
  The independent effect of HLA-DR mismatches on adverse graft survival is diminished under potent antibody induction and maintenance immunosuppression in our predominantly African-American population.
authors.affiliation: Division of Transplantation, Department of Surgery, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.
authors.forename: I
authors.initials: I
authors.lastname: Karabicak
authors.forename: A
authors.initials: A
authors.lastname: Adekile
authors.forename: D A
authors.initials: DA
authors.lastname: Distant
authors.forename: D
authors.initials: D
authors.lastname: O'Shaunessy
authors.forename: S
authors.initials: S
authors.lastname: Lewis
authors.forename: N B
authors.initials: NB
authors.lastname: Sumrani
authors.forename: A J
authors.initials: AJ
authors.lastname: Norin
authors.forename: M O
authors.initials: MO
authors.lastname: Salifu
mesh_terms: D000368:Aged; D044383:Black People; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014481:United States; D001741:Black or African American
chemical_list: D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents