Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients

Lim, Wai H., Chadban, Steve J., Clayton, Philip, Budgeon, Charley A., Murray, Kevin, Campbell, Scott B., Cohney, Solomon, Russ, Graeme R. and Mcdonald, Stephen P. (2012) Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients. Clinical Transplantation, 26 4: E428-E437.

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Author Lim, Wai H.
Chadban, Steve J.
Clayton, Philip
Budgeon, Charley A.
Murray, Kevin
Campbell, Scott B.
Cohney, Solomon
Russ, Graeme R.
Mcdonald, Stephen P.
Title Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients
Journal name Clinical Transplantation  (ERA 2012 Listed)    (ERA 2010 Rank B)   Check publisher's open access policy
Publication date 2012-07
Sub-type Article
DOI 10.1111/j.1399-0012.2012.01654.x
Volume number 26
Issue number 4
ISSN 0902-0063; 1399-0012
Start page E428
End page E437
Total pages 10
Place of publication Malden, MA, U.S.A.
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Abstract Human leukocyte antigen (HLA) mismatches have been shown to adversely affect renal allograft outcomes and remain an important component of the allocation of deceased donor (DD) kidneys. The ongoing importance of HLA mismatches on transplant outcomes in the era of more potent immunosuppression remains debatable. Using Australia and New Zealand Dialysis and Transplant Registry, live and DD renal transplant recipients between 1998 and 2009 were examined. The association between the number of HLA mismatches and HLA-loci mismatches and outcomes were examined. Of the 8036 renal transplant recipients, 59% had between 2 and 4 HLA mismatches. Compared with 0 HLA mismatch, increasing HLA mismatches were associated with a higher risk of graft failure and patient death in the adjusted models. HLA mismatches were associated with an incremental risk of rejection although the relative risk was higher for live donor kidney transplants. Increasing HLA-AB and HLA-DR mismatches were associated with a greater risk of acute rejection, graft failure, death-censored graft failure, and/or death. There was no consistent association between initial immunosuppressive regimen and outcomes. Our results corroborate and extend the previous registry analyses demonstrating that HLA mismatches are associated with poorer transplant outcomes independent of immunosuppression and transplant era.
Keyword ANZDATA registry
Graft survival
Human leukocyte antigen
Kidney transplant
Rejection
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article
Collections: Official 2013 Collection
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Created: Tue, 31 Jul 2012, 14:33:53 EST by Matthew Lamb on behalf of School of Medicine