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Friday, November 30, 2012

Association of HLA Mismatch With Death With a Functioning Graft A...

Association of HLA Mismatch With Death With a Functioning Graft After Kidney Transplantation: A Collaborative Transplant Study Report

Authors: Opelz, G.; Döhler, B.

Source: American Journal of Transplantation, Volume 12, Number 11, 1 November 2012 , pp. 3031-3038(8)

Abstract:

HLA mismatches may correlate with risk of death with a functioning graft (DWFG) because of requirement for higher immunosuppression doses and more antirejection therapy. Deceased-donor kidney transplants (n = 177 584) performed 1990-2009 and reported to the Collaborative Transplant Study were analyzed. The incidence of DWFG was found to be 4.8% during year 1 posttransplant and 7.7% during years 2-5 (Kaplan-Meier estimates). Most frequent causes of DWFG were infection, cardiovascular disease and malignancy (32.2%, 30.9% and 3.6% in year 1; 16.4%, 29.6% and 15.9% in years 2-5). HLA-A + B + DR mismatches were significantly associated with DWFG during year 1 (p < 0.001), a correlation that diminished but persisted during years 2-5 (p < 0.001). HLA mismatch was associated with DWFG because of infection (p < 0.001 during year 1, p = 0.043 during years 2-5) or cardiovascular disease (p < 0.001 during year 1, p = 0.030 during years 2-5) but not malignancy. There was also a significant association between HLA mismatch and hospitalization for viral (p < 0.001) or bacterial (p = 0.002) infection. Multivariable analysis showed that mismatches for HLA class II were more strongly associated with both hospitalization and DWFG than mismatches for HLA class I.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1600-6143.2012.04226.x

Affiliations: 1: Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany

Página original: http://www.ingentaconnect.com/content/mksg/ajt/2012/00000012/00000011/art00021


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