A Lifetime Versus a Graft Life Approach Redefines the Importance of HLA Matching in Kidney Transplant Patients
A Lifetime Versus a Graft Life Approach Redefines the Importance of HLA Matching in Kidney Transplant Patients
复制标题
DOI：
10.1097/tp.0b013e3181a9ec89
复制
发表时间：
2009-07-15
期刊：
影响因子：
6.2
通讯作者：
Schold, Jesse D.
中科院分区：
文献类型：
--
作者：
Meier-Kriesche, Herwig-Ulf;Scornik, Juan C.;Schold, Jesse D.
介绍。人类白细胞抗原（HLA）匹配在同种异体肾移植分配中已经不再被重视，在新的器官共享肾脏分配模型中，计划进一步降低匹配的重要性。匹配不良的所有不可预见的后果都可能增加对寻求再移植的候选人的敏感性。我们检查了1988年至2007年在美国从科学肾移植登记（SRTR）数据库中列出的在原发肾移植失败后重新列出的候选患者（n = 15,980）。主要结果是从受体首次移植前到移植后的整体反应性抗体（PRA）的变化。在一般线性模型中检查了PRA水平的绝对变化，在logistic模型中检查了新敏化的可能性。在首次接受0个HLA-A、-B、-DR或0个HLA-A、-B错配肾移植的患者中，PRA无明显变化；相反，由于首次移植时HLA错配的增加，PRA显著增加。只有10%的患者在0 HLA- a， - b错配移植后变得敏感，而随着HLA错配的增加，这一比例上升到37%。其他因素，尤其是年轻和非裔美国人的种族，也导致了重新上市时更高的PRA。尽管HLA配型对急性排斥反应和移植存活的影响可能有限，但患者在需要第二次移植时，可能会因第一次肾移植的HLA配型不佳而受到负面影响。这对于预期寿命较长的患者尤其重要，因为他们一生中需要第二次移植的可能性很高。
Introduction. Human leukocyte antigen (HLA) matching has been de-emphasized in the allocation of renal allografts and further discounting is planned in the new United Network of Organ Sharing kidney allocation model. Ail unforeseen consequence of poorer matching could be increased sensitization for candidates pursuing retransplantation.Methods. We examined candidates listed in the United States from 1988 to 2007 from the Scientific Renal Transplant Registry (SRTR) database that were relisted after loss of a primary kidney transplant (n = 15,980). The primary outcome was change in panel reactive antibody (PRA) from prior to recipient's initial transplant to the Subsequent listing. Absolute change in PRA levels were examined in general linear models and the likelihood of becoming newly sensitized in logistic models.Results. There was no appreciable change in PRA for patients receiving a first 0 HLA-A, -B, -DR, or 0 HLA-A, -B-mismatched kidney transplant; contrariwise, there was a significant increase in PRA by increasing HLA mismatch of the first transplant. Only 10% of patients became sensitized after a 0 HLA-A, -B-mismatched transplant, whereas the proportion rose up to 37% with increasing HLA mismatches. Other factors, notably younger age and African American race, also contributed to a higher PRA at relisting.Conclusions. Although there might be a limited impact of HLA matching on acute rejection and graft survival, mail), patients might be negatively impacted from poor HLA matching of their first kidney transplant when needing a second transplant. This might be particularly important in patients with a long life expectancy because of the high likelihood of needing a second transplant during their lifetime.