Abstract
Background: For a second kidney transplantation (2nd KT), many transplant
centers systematically avoid repeat HLA antigen mismatches (RMM) with the
previous donor. This precaution comes at the price of a potential increase in
waiting time. We hypothesized that, since highly sensitive anti-HLA antibody
assays have become standard of care, 2nd KT with 1 or more RMM have no
inferior graft survival compared to 2nd KT with no RMM because harmful RMM
could now be accurately identified and selectively avoided.
Methods: We performed an analysis of the Collaborative Transplant Study
(CTS) registry including data of 6711 patients who had received a 2nd KT
between 2010 and 2021, with at least one HLA-A, -B or -DR mismatch.
Results: No significant difference in death-censored graft loss (DCGL) was
observed between 2nd KT with no RMM compared to 2nd KT with ≥1 RMM (HLA
Class 1 or Class 2) in univariate and multivariate analysis. However, a higher
DCGL was observed for recipients with ≥ 1 Class 2 only RMM compared to
≥ 1 Class 1 only RMM and no RMM with significance at 1 year in univariate
analysis (P=0.011) (Figure). Multivariate analysis showed a doubling of the risk
of 1-year DCGL (HR 2.02; 95% CI 1.40 to 2.91; P<0.001) and a 56% increase
of the risk of 5-year DCGL (HR 1.56; 95% CI 1.16 to 2.11; P=0.003) for 1 Class
2 only RMM compared to no RMM. For recipients with a Class 1 RMM only, no
significantly increased risk was observed in 1-year DCGL (HR 1.07; 95% CI
0.81 to 1.40; P=0.64) and 5-year DCGL (HR 0.98; 95% CI 0.79 – 1.21; P=0.82)
compared to no RMM.
Conclusions: Our observations suggest that HLA Class 1 RMM with the first
donor do not need to be systematically avoided. On the other hand, HLA Class
2 RMM have a detrimental impact on early and late graft survival in patients who
receive a 2nd KT at present times, suggesting modern anti-HLA antibody assays
lack accuracy to identify harmful Class 2 RMM. Based on our observations,
caution remains warranted for the acceptance of HLA Class 2 RMM.
centers systematically avoid repeat HLA antigen mismatches (RMM) with the
previous donor. This precaution comes at the price of a potential increase in
waiting time. We hypothesized that, since highly sensitive anti-HLA antibody
assays have become standard of care, 2nd KT with 1 or more RMM have no
inferior graft survival compared to 2nd KT with no RMM because harmful RMM
could now be accurately identified and selectively avoided.
Methods: We performed an analysis of the Collaborative Transplant Study
(CTS) registry including data of 6711 patients who had received a 2nd KT
between 2010 and 2021, with at least one HLA-A, -B or -DR mismatch.
Results: No significant difference in death-censored graft loss (DCGL) was
observed between 2nd KT with no RMM compared to 2nd KT with ≥1 RMM (HLA
Class 1 or Class 2) in univariate and multivariate analysis. However, a higher
DCGL was observed for recipients with ≥ 1 Class 2 only RMM compared to
≥ 1 Class 1 only RMM and no RMM with significance at 1 year in univariate
analysis (P=0.011) (Figure). Multivariate analysis showed a doubling of the risk
of 1-year DCGL (HR 2.02; 95% CI 1.40 to 2.91; P<0.001) and a 56% increase
of the risk of 5-year DCGL (HR 1.56; 95% CI 1.16 to 2.11; P=0.003) for 1 Class
2 only RMM compared to no RMM. For recipients with a Class 1 RMM only, no
significantly increased risk was observed in 1-year DCGL (HR 1.07; 95% CI
0.81 to 1.40; P=0.64) and 5-year DCGL (HR 0.98; 95% CI 0.79 – 1.21; P=0.82)
compared to no RMM.
Conclusions: Our observations suggest that HLA Class 1 RMM with the first
donor do not need to be systematically avoided. On the other hand, HLA Class
2 RMM have a detrimental impact on early and late graft survival in patients who
receive a 2nd KT at present times, suggesting modern anti-HLA antibody assays
lack accuracy to identify harmful Class 2 RMM. Based on our observations,
caution remains warranted for the acceptance of HLA Class 2 RMM.
| Original language | English |
|---|---|
| Title of host publication | Esotcongress |
| Pages | 141 |
| Number of pages | 1 |
| Volume | 21 |
| Edition | 21 |
| Publication status | Published - 2023 |
| Event | 2023 European Society for Organ Transplantation congress Athens - Athene, Greece Duration: 18 Sep 2023 → 20 Sep 2023 |
Conference
| Conference | 2023 European Society for Organ Transplantation congress Athens |
|---|---|
| Country/Territory | Greece |
| City | Athene |
| Period | 18/09/23 → 20/09/23 |
Keywords
- REPEAT HLA CLASS 2 MISMATCHES
- kidney transplantation