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Kidney Outcomes 2

Tuesday September 24, 2024 - 16:50 to 18:30

Room: Beyazıt

360.8 Repeat HLA Class II but not Class I mismatches are associated with increased loss of second kidney grafts: a contemporary Collaborative Transplant Study (CTS) analysis

Karl M Wissing, Belgium

Head Nephrology Department
Nephrology
Universitair Ziekenhuis Brussel

Abstract

Repeat HLA Class II but not Class I mismatches are associated with increased loss of second kidney grafts: A contemporary Collaborative Transplant Study (CTS) analysis

Lissa Pipeleers1, Christian Unterrainer2, Marie-Paule Emonds3,4, Karl Martin Wissing1, Thuong Hien Tran2.

1Department of Nephrology, Universitair Ziekenhuis Brussel, Brussels, Belgium; 2Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany; 3Histocompatibility and Immunogenetics Laboratory (HILA), Belgian Red Cross-Flanders, Mechelen, Belgium; 4Department of Microbiology, Immunology and Transplantation, KU Leuven University , Leuven, Belgium

Introduction: Previous registry studies indicated that repeat HLA mismatches (RMM) were associated with a greater risk of graft loss. Given current routine use of sensitive antibody detection assays that can prevent the transplantation of RMM in hosts with detectable levels of donor-specific antibodies, we hypothesized that RMM would no longer be associated with graft loss in a contemporary cohort of second kidney transplant (2nd KT) recipients.
Methods: We performed a retrospective analysis of the Collaborative Transplant Study database 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 increased risk for graft loss was observed for 2nd  KT with a Class I RMM. For 2nd  KT with a Class II RMM, 1- and 5-year death-censored graft survival was significantly lower (88.8% and 80.0%) compared to recipients with no RMM (93.2% and 84.3%, P=0.003 and P=0.02) (Figure). The multivariate Cox regression analysis hazard ratio for graft loss in the first year after transplantation was 1.98 (95% CI 1.37 to 2.86; P<0.001) for Class II RMM compared to no RMM recipients. The hazard ratio increased to 2.72 (95% CI 1.56 – 4.73; P<0.001) for sensitized recipients (latest PRA>0%) with a Class II RMM.
Discussion: Our observations suggest that HLA Class I RMM with the first donor do not need to be systematically avoided. In contrast, HLA Class II RMM still have a detrimental impact on survival of 2nd KT, despite the widespread availability of Luminex technology.

References:

[1] Repeat kidney transplantation
[2] Repeat HLA antigen mismatches
[3] Kidney graft survival
[4] Registry analysis
[5] Anti-HLA antibodies
[6] Luminex technology

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