title: Kidney Transplantation With Ultralong-Term (42 Years) Survival of a 100-Year-Old Graft.
abstract: BACKGROUND
  In kidney transplantation, long-term graft survival has improved over the last few decades. Study to understand ultralong-term graft survival with graft functioning is rare, but a few researchers have tried to explain the factors involved in long-term graft survival. In this report, we explore the predictive factors that can be involved in ultralong-term graft survival.
  
  
  METHODS
  Immunologic evaluations of the patients were performed using crossmatch (XM), serological, and high-resolution HLA typing for 8 loci. A transplant recipient was treated with azathioprine as immunosuppressive monotherapy for 42 years. Donor-specific antibodies (DSAs) were identified using panel reactive antibody single antigen beads (PRA-SAB) followed by EpVix and Matchmaker epitope analysis to define the immunogenic mismatch eplets.
  
  
  RESULTS
  The patient and donor were haploidentical for 7 loci and identical at the HLA-DPA1* locus. Among 61 identified eplet mismatches, DSAs were not detected against 59 eplets after 42 years of exposure to the patient's immune system with the exceptions of antibodies against the public eplets 9Y and 9YL from allele HLA-DPB1*03:01, and the transplanted kidney exhibited preserved structures.
  
  
  CONCLUSIONS
  The transplanted kidney has the preserved structure based on magnetic resonance imaging, the 2 DSAs were not deleterious to the graft until now, and the eplet mismatches were considered acceptable. The patient is in good clinical condition living with a 100-year-old graft, a serum creatinine level of 1.5 mg/dL, and an estimated glomerular filtration rate of 50 mL/1.72 m2.
authors.affiliation: Kidney Transplantation Center, Clinical Hospital, Belo Horizonte, Minas Gerais, Brazil; Institute of Medical Sciences, Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Laboratory of Histocompatibility and Immunogenetic, Belo Horizonte, Minas Gerais, Brazil. Electronic address: evaldo.nascimento@cienciasmedicasmg.edu.br.
authors.forename: E
authors.initials: E
authors.lastname: Nascimento
authors.affiliation: Kidney Transplantation Center, Clinical Hospital, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: F M
authors.initials: FM
authors.lastname: Lucas-Junior
authors.affiliation: Institute of Medical Sciences, Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Laboratory of Histocompatibility and Immunogenetic, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: R A
authors.initials: RA
authors.lastname: Fabreti-Oliveira
authors.affiliation: IMUNOLAB-Laboratory of Histocompatibility and Immunogenetic, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: B
authors.initials: B
authors.lastname: Vilela
authors.affiliation: Kidney Transplantation Center, Clinical Hospital, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: E R F
authors.initials: ER
authors.lastname: Tavora
authors.affiliation: Kidney Transplantation Center, Clinical Hospital, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: J P L
authors.initials: JP
authors.lastname: Silva
authors.affiliation: Kidney Transplantation Center, Clinical Hospital, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Salomão-Filho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000378:metabolism; D001379:Azathioprine / Q000627:therapeutic use; D000939:Epitopes / Q000276:immunology; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology / Q000502:physiology*; D006680:HLA Antigens / Q000276:immunology; D059867:HLA-DP alpha-Chains / Q000276:immunology; D059868:HLA-DP beta-Chains / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D019737:Transplants / Q000276:immunology
chemical_list: D000906:Antibodies; D000939:Epitopes; D006680:HLA Antigens; D059867:HLA-DP alpha-Chains; D059868:HLA-DP beta-Chains; C071172:HLA-DPA1 antigen; C071170:HLA-DPB1 antigen; D007166:Immunosuppressive Agents; D001379:Azathioprine