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Repeat Donor HLA Mismatch Antigens and Kidney Transplant Outcome

P. Lokhandwala,1 M. Wang,2 Z. Kadry,3 R. Shah,3 A. Jain,3 J. Gaspari,1 N. Ghahramani,4 C. Abendroth,1 H. Shike.1

1Pathology, Penn State Hershey Medical Center, Hershey, PA
2Public Health Sciences, Penn State College of Medicine, Hershey
3Transplant Surgery, PSHMC, Hershey
4Nephrology, PSHMC, Hershey.

Meeting: 2015 American Transplant Congress

Abstract number: A112

Keywords: Graft failure, HLA antibodies, HLA matching, Rejection

Session Information

Session Name: Poster Session A: Kidney Antibody Mediated Rejection

Session Type: Poster Session

Date: Saturday, May 2, 2015

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

Background: Historically, poorer outcome has been reported in kidney re-transplant patients with repeat HLA mismatch antigens. Transplant practice has evolved. Risk of repeat mismatch antigen was re-evaluated.

Methods: Retrospective review of patients who received ABO-compatible kidney transplant with negative T/B lymphocyte crossmatch (AHG-CDC or flow cytometry) between 2003-2013 was performed. Excluded were patients with less than one year follow-up or patients who received zero-antigen mismatch kidney for HLA-A, B, C, DR, and DQ. Donor specific antibody (DSA by LABScreen), T cell mediated (TCM) rejection (biopsy), and graft loss (death-censored) were evaluated as patient outcome. Outcomes of re-transplant patients with repeat mismatch antigens (Group 1; N=21) was compared to re-transplant patients without repeat mismatch antigens (Group 2; N=36) and to patients with no previous transplant (Group 3; N=261).

Results: There was no significant difference in the three groups in follow-up period (overall 5.3 ± 3.0 years) or number of mismatch antigens (overall 6.9 ± 2.4). In Group 1, repeat mismatch antigens were HLA-class I (N=14, 66.7%), class II (N=3, 14.3%), or both class I and II (N=4, 19.0%). There were more sensitized patients (as evaluated by PRA>20%) in Group 1 (33.3%) and 2 (50%) than Group 3 (6.1%, p<0.001). Group 1 was not significantly different from the other two groups in developing de novo DSA, TCM rejection, and graft loss (all p-values >0.05 between any groups). Regardless of patient groups, higher relative risk (RR) of graft failure was seen in patients with DSA (RR=3.19, 95% CI: 1.81-5.64, p=0.0003) or DSA with TCM rejection (RR=4.61; 95% CI: 2.66-7.97, p<0.0001), indicating importance of patient monitoring in all groups.

Outcome Group 1 (N=21) Group 2 (N=36) Group 3 (N=261)
  N (%) N (%) N (%)
DSA Total 6 (28.6) 8 (22.2) 48 (18.4)
DSA de novo 4 (19.0) 6 (16.7) 47 (18.0)
DSA anamnestic 1 (4.8) 0 (0) 1 (0.4)
DSA preformed 1 (4.8) 2 (5.6) 0 (0)
Cellular rejection 6 (28.6) 14 (38.9) 89 (34.1)
Graft loss 4 (19.0) 4 (11.1) 31 (11.9)

Conclusion: Repeat mismatch antigen in kidney re-transplantation is not significantly associated with adverse outcome. Post-transplant monitoring is important regardless of repeat mismatch antigens.

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To cite this abstract in AMA style:

Lokhandwala P, Wang M, Kadry Z, Shah R, Jain A, Gaspari J, Ghahramani N, Abendroth C, Shike H. Repeat Donor HLA Mismatch Antigens and Kidney Transplant Outcome [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/repeat-donor-hla-mismatch-antigens-and-kidney-transplant-outcome/. Accessed May 8, 2025.

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