The Lewis system and kidney transplantation

Area of Science:

• Immunology
• Transplantation Science
• Histocompatibility

Background:

• Lewis antigens play a role in immune responses.
• Previous studies suggest Lewis antigens influence renal transplant outcomes.
• The impact of Lewis antigens in specific high-risk patient groups requires further investigation.

Purpose of the Study:

• To investigate the effect of Lewis antigen status on cadaver kidney graft survival.
• To determine if the effect of Lewis antigens is more pronounced in high-risk transplant recipients.

Main Methods:

• Analysis of data from 1,300 North American kidney transplants.
• Comparison of graft survival rates between Lewis-positive and Lewis-negative recipients.
• Stratification of analysis based on patient risk factors: age, race, and transplant center performance.

Main Results:

• Lewis-negative recipients showed an 8% lower kidney graft survival rate (P=0.05).
• The negative impact of Lewis antigens was amplified in high-risk groups: older than 30 years (14%), non-Caucasians (12%), and transplants at lower-performing centers (12%).
• The most significant effect was observed in non-Caucasians at lower-performing centers (18%, P=0.01).

Conclusions:

• Lewis antigens function as a histocompatibility system in renal transplantation.
• The influence of Lewis antigens on graft survival is significantly greater in high-risk patient populations.
• These findings underscore the importance of considering Lewis antigen status in kidney transplantation, particularly for at-risk individuals.