title: Deleterious impact of HLA-DRB1 allele mismatch in sensitized recipients of kidney retransplants.
abstract: BACKGROUND
  Whether mismatches between donor and recipient of a kidney transplant at the HLA allele level can elicit an immune response strong enough to impact graft survival is not known.
  
  
  METHODS
  We examined the influence of HLA-DRB1 allele level mismatch on graft survival based on high-resolution typing, utilizing blood samples and clinical data provided by the Collaborative Transplant Study. HLA-DRB1*04 was selected as a model for this investigation because it is the most common HLA-DRB1 allele group and consists of several alleles with relatively high frequencies, allowing for analysis of transplants matched at the antigen level but mismatched at the allele level. Nine hundred and ninety-six recipient/donor pairs were typed for HLA-DRB1 at high resolution.
  
  
  RESULTS
  No effect of HLA-DRB1*04 allele mismatch was observed in first transplants. However, in retransplants, HLA-DRB1*04 allele mismatch was associated with significantly decreased graft survival, albeit only in sensitized (PRA>5%) patients (hazard ratio 3.98, P=0.014).
  
  
  CONCLUSIONS
  Our finding reinforces the concept that HLA compatibility significantly influences the outcome of kidney transplants, in sensitized retransplant recipients even at the allele level.
authors.affiliation: Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinold
authors.forename: Gerhard
authors.initials: G
authors.lastname: Opelz
authors.forename: Bernd
authors.initials: B
authors.lastname: Döhler
authors.forename: Christian
authors.initials: C
authors.lastname: Unterrainer
authors.forename: Sabine
authors.initials: S
authors.lastname: Scherer
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruhenstroth
authors.forename: Thuong
authors.initials: T
authors.lastname: Hien Tran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D005260:Female; D006085:Graft Survival; D059811:HLA-DRB1 Chains / Q000235:genetics*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models
chemical_list: D059811:HLA-DRB1 Chains