Successful use of 6 antigen HLA mismatched kidneys for cadaveric renal transplantation
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Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Khalid Chiad Safi1, Ponnusamy Mohan, Ming Lee
1Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland.
Insights
Kidney transplants using kidneys with 6 antigen HLA mismatches show effective outcomes. This study found high patient and graft survival rates, demonstrating the viability of using these kidneys in transplantation.
Area of Science:
- Nephrology
- Immunology
- Transplantation Science
Background:
- Human Leukocyte Antigen (HLA) matching is crucial in organ transplantation to minimize rejection.
- High HLA mismatches traditionally pose challenges for graft survival.
Purpose of the Study:
- To evaluate the outcomes of kidney transplantation using donor kidneys with 6 antigen HLA mismatches.
- To assess graft survival and patient outcomes in this specific donor-recipient pairing.
Main Methods:
- Retrospective analysis of 1,270 cadaveric renal transplants, focusing on 33 cases with 6 antigen HLA mismatches.
- Patients received triple immunosuppression including a calcineurin inhibitor, steroids, and azathioprine.
- Negative cross-matching was a prerequisite for all transplants.
Main Results:
- One-year patient and graft survival rates were high at 93.3% and 93.7%, respectively.
- Immediate graft function was observed in 94% of cases.
- Graft loss occurred in 30% over a mean follow-up of 3.31 years, primarily due to death with a functioning graft (60%) or chronic rejection (40%).
Conclusions:
- Kidneys with 6 antigen HLA mismatches can be effectively utilized in transplantation.
- Careful patient selection and immunosuppression protocols contribute to successful outcomes.
Purpose:
We retrospectively evaluated the outcome of transplantation with kidneys with 6 antigen HLA mismatches.
Materials And Methods:
From October 1990 to September 2001, 1,270 cadaveric renal transplants were performed at our center, including 33 (2.59%) involving recipients of kidneys with 6 antigen HLA mismatches. Mean recipient age +/- SD was 40.2 +/- 14.4 years. Of the 33 recipients 19 were male, 14 were female, 31 received an initial transplant, 4 had diabetes and 6 had panel-reactive antibodies of greater than 10%. Mean donor age was 30.3 +/- 13.7 years and mean cold ischemia time was 22.9 +/- 7.8 hours. All recipients had negative current and previous B and T-cell lymphocytotoxicity cross-matching and all received a triple immunosuppression regimen consisting of the calcineurin inhibitor cyclosporine or tacrolimus combined with steroids and azathioprine.
Results:
One-year patient and graft survival was 93.3% and 93.7%, respectively. Of the 33 grafts 31 (94%) functioned immediately. During the mean followup of 3.31 years 10 grafts (30%) were lost, including 6 (60%) due to death with a functioning graft and 4 due to chronic rejection. Acute rejection in 8 patients (24%) was reversed in 7 by steroid pulses. No graft was lost to acute rejection. Technical complications included wound infection in 2 patients (6%), transplant-ureteral obstruction in 1 (3%) and a urinary fistula in 1 (3%).
Conclusions:
Kidneys with 6 antigen HLA mismatches can be used effectively.
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