The impact of repeated mismatches in kidney transplantations performed after nonrenal solid organ transplantation

The aim of this study was to determine whether kidney transplantations performed after previous nonrenal solid organ transplants are associated with worse graft survival when there are repeated HLA mismatches (RMM) with the previous donor(s). We performed a retrospective cohort study using data from the Scientific Registry of Transplant Recipients. Our cohort comprised 6624 kidney transplantations performed between January 1, 1990 and January 1, 2015. All patients had previously received 1 or more nonrenal solid organ transplants. RMM were observed in 35.3% of kidney transplantations and 3012 grafts were lost over a median follow‐up of 5.4 years. In multivariate Cox regression analyses, we found no association between overall graft survival and either RMM in class 1 (hazard ratio [HR]: 0.97, 95% confidence interval [CI] 0.89‐1.07) or class 2 (HR: 0.95, 95% CI 0.85‐1.06). Results were similar for the associations between RMM, death‐censored graft survival, and patient survival. Our results suggest that the presence of RMM with previous donor(s) does not have an important impact on allograft survival in kidney transplant recipients who have previously received a nonrenal solid organ transplant.

[1]  John Gill,et al.  Re-Examining Risk of Repeated HLA Mismatch in Kidney Transplantation. , 2016, Journal of the American Society of Nephrology : JASN.

[2]  P. Reese,et al.  Validating Early Post-Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants. , 2016, Clinical journal of the American Society of Nephrology : CJASN.

[3]  G. Rådegran,et al.  Outcomes after ABO-incompatible heart transplantation in adults: A registry study. , 2015, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[4]  A. Konvalinka,et al.  Utility of HLA Antibody Testing in Kidney Transplantation. , 2015, Journal of the American Society of Nephrology : JASN.

[5]  J. Schold,et al.  Risk Factors for Retransplant Kidney Recipients: Relisting and Outcomes From Patients' Primary Transplant , 2014, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[6]  A. Israni,et al.  OPTN/SRTR 2012 Annual Data Report: Deceased Organ Donation , 2014, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[7]  J M Smith,et al.  OPTN/SRTR 2012 Annual Data Report: Kidney , 2014, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[8]  G. Klintmalm,et al.  De Novo Donor‐Specific HLA Antibodies Decrease Patient and Graft Survival in Liver Transplant Recipients , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[9]  A. Webster,et al.  Consensus Guidelines on the Testing and Clinical Management Issues Associated With HLA and Non-HLA Antibodies in Transplantation , 2013, Transplantation.

[10]  D. Hricik,et al.  Independent of Nephrectomy, Weaning Immunosuppression Leads to Late Sensitization After Kidney Transplant Failure , 2012, Transplantation.

[11]  P. Nickerson,et al.  Evolution and Clinical Pathologic Correlations of De Novo Donor‐Specific HLA Antibody Post Kidney Transplant , 2012, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[12]  Cihi Snapshot,et al.  Treatment of end-stage organ failure in Canada. , 2012, Healthcare quarterly.

[13]  N. Banner,et al.  De Novo Donor HLA‐Specific Antibodies after Heart Transplantation Are an Independent Predictor of Poor Patient Survival , 2011, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[14]  S. Jameson,et al.  Diversity in T cell memory: an embarrassment of riches. , 2009, Immunity.

[15]  S. Mulgaonkar,et al.  Renal Transplantation in Patients With Pre‐Transplant Donor‐Specific Antibodies and Negative Flow Cytometry Crossmatches , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[16]  F. Rehman,et al.  Re-exposure to Mismatched HLA Class I Is a Significant Risk Factor for Graft Loss: Multivariable Analysis of 259 Kidney Retransplants , 2007, Transplantation.

[17]  B. Einollahi,et al.  Kidney retransplantation in comparison with first kidney transplantation. , 2005, Transplantation proceedings.

[18]  R. Wolfe,et al.  Chronic renal failure after transplantation of a nonrenal organ. , 2003, The New England journal of medicine.

[19]  D. Kaufman,et al.  Immunosuppression: practice and trends , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[20]  D. Gjertson A multi-factor analysis of kidney regraft outcomes. , 2002, Clinical transplants.

[21]  P. Coriat,et al.  [Renal retransplantation in adults. Comparative prognostic study]. , 1999, Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie.

[22]  A. Matas,et al.  Does re-exposure to mismatched HLA antigens decrease renal re-transplant allograft survival? , 1996, Clinical transplantation.

[23]  G. Opelz Repeated HLA mismatches increase the failure rate of second kidney transplants. Collaborative Transplant Study. , 1995, Transplantation proceedings.

[24]  P. Terasaki,et al.  Repeating HLA antigen mismatches in renal retransplants--a second class mistake? , 1994, Transplantation.

[25]  P. Terasaki,et al.  Absence of immunization effect in human-kidney retransplantation. , 1978, The New England journal of medicine.