Aims: HLA DR matching has shown measureable significant effects in kidney graft survival. Part and parcel of this association is the HLA Class II allele repertoire of peptide ligands presented to the Tcell receptor. Prior studies have shown HLA Class II receptor restricted T cell epitopes termed "Tregitopes" are stimulated to suppress the immune response. Using this as our operating hypothesis we chose to examine the effect of HLA DR Class II antigens reported to the UNOS registry examining the matching effect for specific HLA DR antigens. HLA DR was chosen because it represented the most complete Class II data base.

Methods: During 2000-2013, a total of 133,235 patients who received a first deceased donor kidney transplant were included in this study using the UNOS data as of Sept. 30, 2014. In figure 1 below compares 0DRMM no DR10,14,16 versus 0DRMM 10,14,16 match are compared. In Figure 2; 0,1,2 DRMM are compares to 1DRMM for 10,14,16. Cox regression analysis was performed to account for confounding variables.

Results: Zero HLA DR MM versus HLA DR 10,14,16 showed a significant difference (P<0.001) and interestingly even with 1MM HLA DR10,14,16 there was a significant diference compare to 0MM HLA DR. Graft survival was checked when HLA DR 10,14,16 were 2MM but no deleterious graft survival effects were seen. Cox regression analysis was performed with an adjusted HR of 0.9 (p<0.004).

Conclusions: HLA DR10,14,16 1&0MM had a superior graft survival supporting a change in points for matching these antigens. It is postulated the ligand peptide repertoire are Tregatopes inducing Tregs or the ligand repertoire is enhances histocompatibility responsiveness; therefore, matching produces a superior result.

CITATION INFORMATION: Cicciarelli J, Cho Y, Altrich M, Kasahara N, Lemp N. Zero and One Mismathing for HLA DR10,14,16 Produces Increased Kidney Graft Survival. Am J Transplant. 2016;16 (suppl 3).

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