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The impact of center variation on the HLA-DR matching effect in kidney graft survival
J Thorogood1, J C van Houwelingen, J J van Rood
1Eurotransplant Foundation, Leiden University, The Netherlands.
Insights
Human Leukocyte Antigen (HLA)-DR matching significantly impacts kidney transplant success. Better HLA-DR matching improves graft survival, especially when using cyclosporine (CsA).
Area of Science:
- Nephrology
- Immunology
- Transplantation Science
Background:
- Kidney transplantation is a vital treatment for end-stage renal disease.
- Histocompatibility, particularly Human Leukocyte Antigen (HLA) matching, is crucial for graft survival.
- The role of HLA-DR matching in cadaveric kidney transplants requires further elucidation, especially with evolving immunosuppressive therapies.
Purpose of the Study:
- To evaluate the impact of HLA-DR matching on the prognosis of first-cadaver kidney transplants.
- To assess the influence of HLA-DR mismatching on graft survival within the first year post-transplantation.
- To analyze the interaction between HLA-DR matching and cyclosporine (CsA) use on transplant outcomes.
Main Methods:
- Analysis of data from 7436 first-cadaver kidney transplants performed between 1981 and 1986.
- Inclusion of data from 50 Eurotransplant follow-up centers.
- Statistical adjustment for the use of cyclosporine (CsA) and center-specific graft survival variations.
Main Results:
- HLA-DR matching demonstrated a highly significant effect on graft prognosis, independent of CsA use and center variations.
- Each increment in HLA-DR mismatch increased the relative risk of graft failure by 1.4-fold.
- Predicted one-year graft survival rates were substantially higher with better HLA-DR matching, particularly in patients receiving CsA (86.5% for 0 mismatches vs. 75.4% for 2 mismatches).
Conclusions:
- HLA-DR matching remains a critical factor for optimizing first-cadaver kidney transplant outcomes.
- Improved HLA-DR matching significantly enhances graft survival, with a pronounced benefit observed in patients treated with cyclosporine.
- These findings underscore the importance of HLA-DR compatibility in donor-recipient selection for kidney transplantation.
Abstract:
Data from 7436 cases of first-cadaver transplants between 1981 and 1986 from 50 transplant follow-up centers within Eurotransplant, were analyzed with respect to the effect of HLA-DR matching on graft prognosis within the first year posttransplant. The use of cyclosporine was allowed for as well as the variation in graft survival rate between transplant follow-up centers. After adjustment for these variables, HLA-DR matching was still very significant. The effect of CsA on graft survival varied between centers--i.e., interaction was observed--but the effect of HLA-DR mismatching did not vary significantly between centers. Over all the centers there was a 1.4-fold increase in relative risk for each increase in HLA-DR mismatch, corresponding to predicted one-year graft survivals of 86.5%, 81.9%, and 75.4% for 0, 1, and 2 HLA-DR mismatches respectively, in patients receiving CsA, and 72.5%, 64.2%, and 53.6% in patients not receiving CsA.