| Autor: |
Bryan, Cf, Shield, Cf, Pierce, Ge, Warady, Ba, Aeder, Mi, Martinez, J, Luger, Am, Nelson, Pw, Ross, G, Muruve, N, Mitchell, Si |
| Předmět: |
|
| Zdroj: |
Clinical Transplantation; Feb2000, Vol. 14 Issue 1, p79-84, 6p, 2 Charts, 2 Graphs |
| Abstrakt: |
The purpose of our investigation was to evaluate long-term graft survival and the role of histocompatibility in patients who were highly sensitized to human leukocyte antigen (HLA) Class I antigens and received a cadaveric renal transplant. Our multi-institutional study evaluated 7-yr graft outcomes and the histocompatibility requirements of 61 (6.1%) highly sensitized (anti-human globulin panel reactive antibody [AHG PRA], ≥80%) cadaveric renal transplantation patients, transplanted between 1988 and 1997, among 999 consecutive cadaveric renal transplants.One- and 7-yr graft survival in the high PRA group (n=61) was 76 and 59%, and was not significantly different from that in the low PRA group (n=938), 86 and 59% (Wilcoxon=0.11; log-rank=0.45) (died with a functioning graft [DWFG] not censored). When those data were divided into primary and regrafts, 1- and 7-yr graft outcomes for high and low PRA groups were not significantly different [(primary, 1- and 7-yr survival: high PRA=83 and 74%, n=30, and low PRA=87 and 61%, n=825; log-rank=0.37 for DWFG not censored) (regrafts, 1- and 7-yr survival: high PRA=70 and 42%, n=31, and low PRA=80 and 43%, n=113; log-rank=0.36 for DWFG not censored)]. We did observe a subgroup of the high PRA patient group that had inferior graft outcomes. Graft outcome at 1 and 6 yr in the high PRA group for patients who had one to two DR mismatches (65 and 50%, n=41) was significantly worse than for high PRA patients who had zero DR mismatches with their donors (100 and 78%, n=20) (log-rank=0.01 for DWFG not censored). Furthermore, the mean number of HLA-A and -B mismatches was significantly greater in the high PRA/DR-mismatched group (1.7±1.2, n=41) compared with the high PRA/zero DR-mismatched group (0.5±1.1, n=19) (p<0.001). Overall, these data suggest that the patient who is highly sensitized to HLA Class I antigens has a long-term graft outcome that is equivalent to less sensitized patients, but that HLA-DR mismatching and a higher degree of Class I mismatching may be poor prognostic indicators in such patients. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
|
