title: Immunologic prognostic factors of renal allograft survival.
abstract: BACKGROUND
  Successful outcome of renal transplantation depends on various factors, of which immunologic is one of the most important. Accumulated experience of a single center, with the same surgical and immunological team contributes significantly to safe conclusions. Purpose of this study was the evaluation of potential factors, in particular immunologic, that influence renal allograft survival.
  
  
  METHODS
  During the period 1991-2013, 20,784 surgical operations have been performed in our Department of Surgery - Transplant Unit, of which 575 were renal transplantations. We examined donor and recipient demographic factors, immunologic characteristics along with patient and graft survival.
  
  
  RESULTS
  Renal allograft was retrieved from living-related donor in 103 cases and in 472 from cadaveric donor. Donor age was 46.7 ± 18.5 years old and 49.9% (287) were male. Recipient age was 48 ± 12.3 years old and 402 were male. HLA histocompatibility was carefully matched resulting in 85.5% renal transplants with 2-4 HLA mismatches and 93.8% renal transplants with at least one HLA-DR. Renal graft survival the first, fifth and tenth year was 89%, 76%, and 67% and patient survival was respectively 95%, 89% and 83%. Statistical analysis revealed that only donor age influenced renal graft survival (P < .05). HLA mismatches were not correlated with graft survival (log rank P = .495), but identification of panel reactive antibodies (PRA) class I and class II post transplantation had a statistically significant impact on long term renal graft survival (log rank P < .001 and P = .021, accordingly).
  
  
  CONCLUSIONS
  Analysis of potential prognostic factor showed that only donor age was correlated with allograft survival. Development of PRA following renal transplantation influenced long term graft survival. Good HLA matching with at least one HLA DR resulted in excellent graft and patient survival.
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece; Department of Nephrology, Evangelismos General Hospital of Athens, Athens, Greece. Electronic address: mkoukoulaki@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Koukoulaki
authors.affiliation: Department of Immunology - Histocompatibility, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Kitsiou
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Balaska
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Pistolas
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Loukopoulos
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Drakopoulos
authors.affiliation: Department of Immunology - Histocompatibility, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Athanasiadis
authors.affiliation: Department of Immunology - Histocompatibility, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Tarassi
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Vougas
authors.affiliation: Department of Nephrology, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Metaxatos
authors.affiliation: Department of Nephrology, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Apostolou
authors.affiliation: Department of Immunology - Histocompatibility, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Papasteriadi
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Drakopoulos
authors.affiliation: First Department of Surgery, Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Hadjiyannakis
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology; D006648:Histocompatibility / Q000276:immunology*; D006801:Humans; D007155:Immunologic Factors / Q000276:immunology*; D007668:Kidney / Q000276:immunology*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D006684:HLA-DR Antigens; D007155:Immunologic Factors