The effect of HLA mismatch on highly sensitized renal allograft recipients

Paramesh AS, Zhang R, Baber J, Yau CL, Slakey DP, Killackey MT, Ren Q, Sullivan K, Heneghan J, Florman SS. The effect of HLA mismatch on highly sensitized renal allograft recipients. Clin Transplant 2010: 24: E247–E252. © 2010 John Wiley & Sons A/S. Abstract:  Introduction:  We examined the effects of increasing human leukocyte antigen (HLA) mismatches (MM) on long-term graft outcomes in patients transplanted with a panel reactive antibody (PRA) >80% over a 10-yr period. Methods:  A total of 142 recipients were divided into three groups based on the number of HLA MM with their allograft (0–2, 3–4 and 5–6 MM; Groups I, II and III). All patients received the same immunosuppression protocol. Results:  The higher MM groups had a higher incidence of rejection (4.4% vs. 11.4% vs. 31.3%, p < 0.01). A multivariate analysis showed that rejection was the only significant variable affecting graft loss (OR = 7.45, p = 0.01). There was a trend toward more CMV infection and worse graft function with higher MM. Kaplan–Meier five-yr graft survival estimates were 100% vs. 81% vs. 74% for Groups I, II and III, respectively (p = 0.14). Conclusions:  In patients with PRA levels >80%, a higher HLA MM is associated with higher incidence of acute rejection. Acute rejection was the only significant variable affecting graft loss. We found a trend toward more CMV infections and worse graft outcomes with higher MM. Closer HLA matching and immunologic monitoring needs to be considered to improve graft outcomes among sensitized recipients.