title: Graft and patient outcomes of zero-human leucocyte-antigen-mismatched deceased and live donor kidney transplant recipients.
abstract: Greater compatibility of human leucocyte antigen (HLA) alleles between kidney donors and recipients may lead to improved graft outcomes. This study aimed to compare the incidence of acute rejection and graft failure in zero-HLA-mismatched recipients of living-related (LD) and deceased donor (DD) kidney transplants. Using data from the Australia and New Zealand Dialysis and Transplant Registry, we compared the risk of any acute rejection and biopsy-proven acute rejection (BPAR) and graft failure in recipients of zero-HLA-mismatched kidneys between LD and DD using logistic and Cox regression models. Of the 931 zero-HLA-mismatched recipients transplanted between 1990 and 2012, 19 (2.0%) received kidneys from monozygotic/dizygotic twins (twin), 500 (53.7%) from nontwin LD and 412 (44.3%) from DD. Twin kidney transplant recipients did not experience rejection. Compared to DD transplant recipients, the risk of any acute rejection (adjusted odds ratio 0.52, 95%CI 0.34-0.79, P = 0.002) and overall graft failure (adjusted hazard ratio 0.55, 95%CI 0.41-0.73, P < 0.001) was significantly lower in LD recipients independent of initial immunosuppression, but not for BPAR (adjusted odds ratio 0.52, 95%CI 0.16-1.64, P = 0.263). Zero-HLA-mismatched DD kidney transplant recipients have a significantly higher risk of any acute rejection episodes and graft loss compared to zero-HLA-mismatched LD kidney transplant recipients. A cautious and careful approach in reducing immunosuppression appears to be warranted in this group of transplant recipients.
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Gray
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Chadban
authors.forename: Helen
authors.initials: H
authors.lastname: Pilmore
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000483:Alleles; D001315:Australia; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009520:New Zealand; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D016896:Treatment Outcome; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic; D055815:Young Adult
chemical_list: D006680:HLA Antigens
keywords: Australia and New Zealand Dialysis and Transplant Registry; epidemiology; graft failure; kidney transplantation; zero-HLA mismatch