Objective: Determine the impact of HLA matching on acute cellular rejection (ACR), and graft and patient survival in pancreas txp.
Methods: Retrospective review of 1,063 sequential pancreas txps (293 SPK, 468 PAK, 302 PTA) performed between 1998 and 2011. Univariate and multivariate (MV) Cox models were used to assess the association of donor and recipient characteristics; HLA matching; PRA; DSA; immunosuppression; and pDRI with one-year ACR, DC-graft survival, and patient survival.
Findings: SPK ACR rate (9.2%) was lower than solitary pancreas (27.5 %, p<0.001). PAK (27.5%) and PTA (27.6%) ACR rates were not different (p=0.9), and combined as pancreas alone (PA). In univariate analysis, 0 6-HLA-antigen (A, B, DR) mismatch (0MM) txps had the same ACR as 1-3 MM for both SPK (p=0.6) and PA (P=0.9). 4-6 MM had greater ACR than 1-3MM for PA (p=0.013) but not for SPK (p=0.4). In the MV model, risk factors for ACR included PA txp; female recip; recip age <50; PRA ≥80; and >3 HLA-A, B, and DR mismatches. Not significant and excluded in the final model were current DSA (HR 1.6, p=0.263), re-txp (HR 1.2, p=0.4), pDRI (HR 1.2, p=0.077), alemtuzumab (HR 1.5, p=0.139), steroid maintenance (HR 0.9, p=0.9), and dialysis at txp (HR 0.9, p=0.613).
Examination of HLA loci mismatching revealed that only mismatch in HLA-B was significant, and only for 2MM alleles (Table 1). HLA-A and -DR were not associated with ACR. HLA-C and -DQ matching were not significant (p=0.4-0.9). The impact of HLA matching was only within PA txps and was not significant for SPK (1MM, p=0.2; 2MM p=0.3). In contrast, there was no association of HLA mismatching with patient or graft survival for PA or SPK txps (all p>0.25) in univariate and MV models.
Conclusion: ≥4 HLA-A, -B, and -DR mismatches is associated with an increased risk of ACR. Furthermore, the association was only significant for HLA-B loci mismatching, and only for PA txps.
|Hazard Ratio||P Value||LCL||UCL|
|Recipient ≥ 50||0.647||0.011||0.462||0.906|
|PRA ≥ 80||1.649||0.011||1.124||1.504|
|Number HLA-A MM|
|Number HLA-B MM|
|Number HLA-DR MM|
|One Year||Five Year||Ten Year|
|0 HLA-B MM||81.7%||54.8%||52.2%|
|1 HLA-B MM||79.5%||60.0%||52.4%|
|2 HLA-B MM||78.1%||59.6%||50.5%|
To cite this abstract in AMA style:Finger E, Radosevich D, Dunn T, Kukla A, Lohlun J, Sutherland D, Pruett T, Kandaswamy R. Association of HLA-A, B, C, DR, and DQ Matching with Rejection and Survival in Pancreas Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/association-of-hla-a-b-c-dr-and-dq-matching-with-rejection-and-survival-in-pancreas-transplantation/. Accessed December 6, 2019.
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