Authors:
A. Fylaktou (Athens, GR)
G. Miserlis (Thessaloniki, GR)
C. Zarras (GR)
T. Karampatakis (Thessaloniki, GR)
F. Makrovasili (Thessaloniki, GR)
I. Paraskevopoulou (GR)
V. Nikolaidou (Thessaloniki, GR)
V. Papanikolaou (Thessaloniki, GR)
HLA incompatibility is associated with post-transplant adverse consequences in renal transplantation. In this study, the effects of HLA incompatibility on 10 year graft function and survival in renal transplantation were assessed. Outcome analysis was performed in 109 diseased (67) or living (42) donor renal transplantations during 2005-2007. Patients were grouped according to the level of HLA-A, -B and -DR mismatching into two groups, group A with 0-3 incompatibilities (n=74) and group B with 4-6 incompatibilities (n=35). Serum creatinine levels (mg/dl), 24 hour urine protein levels (mg/24h) in 1st, 5th and 10th year post-transplantation were measured along with graft survival, time on waiting list, cold ischemia time, donor and recipient age, donor type (diseased or living) and acute rejection episodes. HLA antibody reaction frequency (% PRA) was also measured. Groups A and B were compared in association with the previous parameters. Statistical analysis was performed through SPSS using t-test, chi-square and Fisher’s exact test at a level of p<0.05. The total graft survival was 85.3%, 81.7% and 80.7% in 1st, 5th, 10th year, respectively. Graft survival was higher in group A in 1st, 5th and 10th year post-transplantation (98.1%, 92.6%, 88.9%, respectively) versus group B (66.7%, 61.9%, 61.9%) (p<0.001, 0.001, 0.007 respectively). 24 hour urine protein in 5th and 10th year was 266.52 and 197.11 in group A, versus 413.29 and 401.6 in group B (p>0.05). 93.1%, 4.2% and 2.8% of patients had PRA 0%, 5-69% and >70%, respectively. No statistically significant differences were observed between the groups in serum creatinine levels, waiting list time, cold ischemia time, donor and recipient age, donor type, % PRA and acute rejection episodes. Although only 2.8% of patients had PRA>70% with no differences in pre-sensitization between the groups, graft survival was significantly superior in group A. This demonstrates that HLA incompatibility is an independent risk factor affecting the 10 year graft survival.