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Effect of HLA-DR3 gene expression on cadaveric renal allograft survival in blacks
T K Ngcobo1, P Becker, M C Modiba
1Department of Surgery, Medical University of Southern Africa (MEDUNSA), South Africa.
Insights
HLA-DR3 gene expression negatively impacts kidney transplant survival in Black South African recipients. This genetic factor is associated with earlier graft loss, highlighting its significance in renal allograft outcomes.
Area of Science:
- Immunogenetics
- Transplantation Science
- Nephrology
Background:
- The Human Leukocyte Antigen (HLA) system plays a crucial role in immune responses and organ transplantation.
- Understanding genetic factors like HLA-DR3 expression is vital for predicting renal allograft outcomes, particularly in specific ethnic populations.
Purpose of the Study:
- To investigate the association between HLA-DR3 gene expression and the survival of kidney allografts in Black South African recipients.
- To determine if HLA-DR3 gene expression is a risk factor for graft loss in this patient cohort.
Main Methods:
- A retrospective study of 70 Black South African patients who received cadaveric renal allografts between 1984 and 1992.
- Analysis of actuarial graft survival rates based on HLA-DR3 gene expression status.
- Comparison of graft loss due to rejection and creatinine levels between HLA-DR3 expressors and non-expressors.
Main Results:
- Patients expressing HLA-DR3 had significantly lower graft survival rates compared to non-expressors (p=0.01).
- Graft loss due to rejection showed a trend towards higher incidence in HLA-DR3 expressors, though not statistically significant (p=0.8).
- No significant difference in creatinine values was observed during the first year post-transplantation between the two groups.
Conclusions:
- HLA-DR3 gene expression is identified as a significant risk factor for earlier graft loss in Black South African renal allograft recipients.
- These findings underscore the importance of HLA-DR3 in predicting transplant outcomes within this specific demographic.
- Further research may explore mechanisms underlying this association to improve transplant strategies.
Abstract:
The effect of HLA-DR3 gene expression was studied in black cadaveric renal allograft recipients of organs from the same donor race. From January 1984 to June 1992, 70 patients received cadaveric renal allografts at the Medical University of Southern Africa (MEDUNSA). The average age and F:M ratio was 30 years and 1: 1.2 respectively. HLA-A, B and DR matching was zero to one in 80%. Actuarial graft survival at yearly intervals in 22 HLA-DR3 gene expressors was 62, 55, 38, 30 and 24% as compared to 82, 78, 70, 64 and 58% in 48 non-HLA DR3 gene expressors (Breslow p = 0.01 and Mantel-Cox p = 0.05). There was no statistical differences in creatinine values associated with HLA-DR3 gene expression during the 1st year after transplantation. Renal allografts were lost from rejection in 9 out of 16 HLA-DR3 gene expressors as compared to 19 out of 29 non-HLA DR3 gene expressors (Fisher's exact test p = 0.8). HLA-DR3 gene expression is a risk factor for earlier graft loss in black South Africans.