title: HLA gene dosage effect on renal allograft survival.
abstract: BACKGROUND
  Human leukocyte antigen (HLA)-A, HLA-B, and HLA-DR matching has beneficial long-term effects on renal allograft survival. However, the gene dosage effect of mismatched HLA on transplant outcomes is not known. We investigated the HLA gene dosage effects on allograft survival in kidney transplant recipients (KTRs).
  
  
  METHODS
  We analyzed HLA typing of KTRs and kidney donors at Kyungpook National University Hospital from January 1982 to December 2012. KTRs were divided into 2 groups: recipients from homozygous HLA donors and recipients from heterozygous HLA donors. Death-censored graft survival of KTRs was compared according to allele state of kidney donors.
  
  
  RESULTS
  In this study, 697 KTRs were enrolled. According to Kaplan-Meier analysis, graft survival in KTRs of HLA-DR and HLA-B heterozygous donors was longer than that in KTRs of HLA-DR and HLA-B homozygous donors (P = .007 and P < .0001, respectively). Multivariate Cox proportional hazards model analysis showed that HLA-DR and HLA-B donor homozygosity was an independent risk factor for death-censored graft survival (P = .019 and P = .022, respectively). Death-censored graft survival was not associated with HLA-A and HLA-A, B, DR allele states.
  
  
  CONCLUSIONS
  Compared with HLA donor mismatch caused by HLA-DR and HLA-B heterozygosity, HLA donor mismatch caused by HLA-DR and HLA-B homozygosity was associated with significantly increased risk of graft failure. In addition to the number of HLA mismatch between KTRs and donors, the donor allele state should be considered to predict transplant outcomes.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End-Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End-Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End-Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End-Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End-Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End-Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: Y-L
authors.initials: YL
authors.lastname: Kim
authors.affiliation: Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: H-K
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: S
authors.initials: S
authors.lastname: Huh
authors.affiliation: Department of Clinical Pathology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: D-I
authors.initials: DI
authors.lastname: Won
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End-Stage Renal Disease in Korea, Daegu, Korea. Electronic address: drcdkim@knu.ac.kr.
authors.forename: C-D
authors.initials: CD
authors.lastname: Kim
mesh_terms: D000328:Adult; D005260:Female; D018628:Gene Dosage; D005819:Genetic Markers; D006085:Graft Survival / Q000235:genetics / Q000276:immunology*; D006680:HLA Antigens / Q000235:genetics*; D006579:Heterozygote; D006650:Histocompatibility Testing; D006720:Homozygote; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D005819:Genetic Markers; D006680:HLA Antigens