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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 6  |  Page : 995-997
Impact of ethnicity, donor status and HLA matching on renal allograft survival: A single center study


Department of Transplant Biology and Stem Cell, Global Hospitals, Lakdi-ka-Pool, Hyderabad (A.P.), India

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Date of Web Publication27-Oct-2009
 

   Abstract 

The role of histocompatibility testing in renal transplantation is passing through an immense debate on its utility in predicting long-term graft survival. The current study, which includes fifty-one patients with end-stage renal disease, aims at evaluating the impact of the HLA matching in live related donor (LRD) (parents, siblings and near relatives) and live unrelated donor (LURD) transplants on one year graft survival rates, in a single center. Patients were followed-up for one-year after renal transplantation and observed for renal complications inclu­ding infections and rejection. The incidence of acute rejection episodes was found to be lower in LRD transplantation complying with many reports published so far. HLA matching was found to be beneficial in obtaining better graft function and one-year graft survival rate. The current study found that patients from Far East of India have lower graft survival rates as against patients from other regions of the country. India, with its vast racial distribution, has a need to look into the ethnic variation and its impact on allograft survival.

How to cite this article:
Chelluri LK, Vasantha A, Ratnakar KS. Impact of ethnicity, donor status and HLA matching on renal allograft survival: A single center study. Saudi J Kidney Dis Transpl 2009;20:995-7

How to cite this URL:
Chelluri LK, Vasantha A, Ratnakar KS. Impact of ethnicity, donor status and HLA matching on renal allograft survival: A single center study. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2019 Dec 10];20:995-7. Available from: http://www.sjkdt.org/text.asp?2009/20/6/995/57252

   Introduction Top


The predictability of HLA compatibility on graft survival is different in different organ transplantations. In bone marrow transplanta­tion, the results of donor selection after HLA matching are excellent while in renal trans­plantation the outcome is a subject of debate. [1],[2],[3],[4] Studies from over 100 transplantation centers in the United States of America (USA) strong­ly recommend the six-antigen match as base­line index for donor selection. [1] However, ex­cellent survival has been reported in small groups of poorly matched patients as well. [4]

This observation suggests the need for further assessment of the usefulness of HLA matching. Several factors influence patient and graft sur­vival in renal transplantation. [5] The survival rates are better with haploidentical live related donors (LRD) than in recipients of cadaver kidneys. [6] Allograft survival at one year, is approximately 90% in HLA identical LRD transplants; 64% in HLA non-identical trans­plants and 50% in cadaver transplantation. [7],[8]

Ethnic variations are also reported in renal graft survival in Caucasians, Asians and Hispanics. [9],[10],[11],[12],[13] The present study is aimed to assess the usefulness of HLA matching in renal trans­plantation from LRD and living unrelated do­nor (LURD) in terms of graft survival rates. The influence of regional variations on renal graft survival was also studied.


   Material and Methods Top


Fifty-one patients with chronic renal failure underwent renal transplantation at our institu­tion. Among them, patients without cardiovas­cular, hepatic or pulmonary disease were cho­sen for the study. Transplant donors were either related/unrelated, HLA identical or haploiden­tical, or healthy adult volunteers. Thirty-two patients received kidneys from LRD while 19 were recipients of LURD kidneys.

HLA typing for Class-I and Class-II MHC antigens was performed by standard micro­lymphocytotoxicity method [14] (Pel Freez, USA). Degree of histocompatibility between the reci­pient and the donor for HLA-ABC, DR, DQ alleles was established by the six-antigen match. [15] Cyclosporine was administered to all transplant recipients along with steroids. Graft function was assessed based on serum crea­tinine levels. [14]

Immunosuppression

The initial dose of cyclosporin A (CsA) ad­ministered to all recipients was 8 mg/kg/day (aggressive dose until the levels are stabilized). Maintenance dose of CsA (3 mg/kg/day), along with steroids, was individualized in each pa­tient to obtain a CsA blood concentration of about 100 ng/mL.

Follow-up

All the recipients were followed-up at one month, three months, six months, nine months and 12 months after transplantation and assessed for the incidence of acute rejection, chronic rejection, infections, and post-operative com­plications. Acute rejection was diagnosed by standard clinical criteria which included a rise in serum creatinine concentration of 0.34 mg/dL or greater per 24 hours in the presence of low or normal whole blood CsA levels (100-400 mg/mL by HPLC). The diagnosis was also his­tologically confirmed. [4]


   Statistical Analysis Top


Student's unpaired t-test was used for statis­tical analysis of the results. A difference bet­ween two groups was considered significant when P was < 0.05.


   Results Top


There were 39 male and 12 female recipients. All donors and recipients were ABO blood group compatible. Demographic features of pa­tients and donors are given in [Table 1]. Mean duration on dialysis in patients, before they underwent transplantation, was 4.62 ± 4.38 months. Amongst LRD, 43.6% of the donors were parents, 36.7% were siblings and 19% were near relatives [Table 1]. The graft survi­val rates in LRD and LURD were 90% and 81% respectively [Figure 1]. The incidence of acute tubular necrosis was 4% and acute re­jection was 6% in LRD as confirmed by the histopathology reports.

The graft survival rates were 89%, 93% and 77% when donors were parents, siblings and near relatives, respectively [Figure 2]. On tissue typing, one case had two haplotype match, 16 had one haplotype match and 14 had zero haplotype match. A statistically significant difference was found in rejection episodes bet­ween these groups; the better matched grafts showed better kidney function than those who had one haplotype or zero haplotype match, at the end of one year [Table 2].

HLA phenotype frequencies (%) observed in North, South, and East Indian populations in­cluded more than 50% similarities with A9, A19 alleles, B12 (44/45), B5(51/52), Cw1, Cw6 alleles of Class-I MHC, and DR1, DR2, DQ2 alleles of Class-II MHC. Public antigens DR52 and DR53 were found in greater fre­quency in the South Indian population. The incidence of rejection was 6% (5/82) in North Indians, 7.7% (6/78) in South Indians and 13% (3/23) in East Indians [Table 1].


   Discussion Top


The major goal of transplantation is to achieve better patient and graft survival. Many investi­gators believe that HLA antigen matching has no effect on the graft outcome. In the present study, HLA matching was found beneficial in obtaining better graft function rates and good functioning graft at one year. These findings concur with the observations of several other investigators. [3],[4],[7],[8]

The incidence of acute tubular necrosis as well as acute rejections was lower in recipients of LRD than in those with LURD in the pre­sent study. Sibling donor transplant appeared to yield better results than that of parent or near relative. The main advantage of LRD transplantation is better long-term results in recipients. Such satisfying results should lead to increase in the number of LRD transplan­tations.

The impact of HLA matching on kidney graft survival is usually easier to assess in Cauca­sians than in kidney recipients among the Blacks, due to difficulties in the serological determination of HLA antigens in the Blacks. [12] It has been observed that renal transplantations have better success rate in Asians, Caucasians and Hispanics. [8],[10],[11],[13] In our study, we found that graft survival was better among North and South Indian patients than in East Indian pa­tients. The reason for this difference needs fur­ther elucidation in frequency of alleles and new cross-reactive groups (CREGS). It was re­cently suggested that the variation in the graft survival rates, observed in some studies could be attributed to the use of regular commer­cially available antisera for tissue typing. [10],[16] . These observed differences may cease to exist when CREGS specific for various ethnic re­gions are developed.

 
   References Top

1.Su X, Zenios SA, Chakkera H, et al. Diminishing significance of HLA matching in Kidney transplantation. Am J Transplant 2004;4:1501.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Opelz G, Dohler B. Effect of Human leukocyte antigen compatibility on kidney graft survival: Comparative analysis of two decades. Transplantation 2007;84:137-43.  Back to cited text no. 2      
3.Terasaki PI, Mickey MR, Iwaki Y, et al. Long term graft survival in kidney grafts. Transplant Proc 1989;21(1):616-7.  Back to cited text no. 3      
4.Cicciarelli J, Iwaki Y, McCalmon R, Thomson J. Renal transplant graft survival results and HLA-A,-B,-DR mismatching. Transplant Proc 1995;27(1):660-3.  Back to cited text no. 4      
5.Naqvi A, Abbas N, Zafar R, et al. Factors influencing patient and graft survival in living related renal transplantation at a single centre. Transplant Proc 1996;28(5):2801.  Back to cited text no. 5      
6.Mouquet C, Benalia H, Barrou B, et al. Kidney transplantation from living related donors. Transplant Proc 1996;28(5):2801.  Back to cited text no. 6      
7.Gorski A. Significance of HLA matching in renal transplantation from living donors.Transplant Proc 1996;28(6):3578.  Back to cited text no. 7      
8.Terasaki PI, Cho YS, Takemoto S, Cecka M, Gjertson D. Twenty year follow-up on the effect of HLA matching on kidney transplant survival and prediction of future twenty-year survival. Transplant Proc 1996;28(3):1451-52.  Back to cited text no. 8      
9.Sumrani N, Hong JH, Georgi B, et al. Impact of early acute rejection on outcome of HLA­mismatched living related donor kidney transplants. Transplant Proc 1996;28(3):1451-­2.  Back to cited text no. 9      
10.Devin EE, Carlton JY, Robert SG, et al. Racial disparities in renal allograft survival: A public health issue? J Am Coll Surg 2007;204:894­-903.  Back to cited text no. 10      
11.Carlton JY, Robert SG. Understanding the influence of ethnicity on renal allograft survival. Am J Transplant 2007;5:2603-4.  Back to cited text no. 11      
12.Carlton JY, Robert SG. Renal transplantation in black Americans. N Engl J Med 2000;343: 1545-52.  Back to cited text no. 12      
13.Isaacs RB, Nock S, Spencer C, et al. Racial disparities in renal transplant outcomes. Am J Kidney Dis 1999;34:706-12.  Back to cited text no. 13      
14.Opelz G, Mytilneous J, Scherer S. Effect of HLA compatibility on kidney transplant survival in Asians. Transplant Proc 1996;28 (3):1451-2.  Back to cited text no. 14      
15.NIH lymphocyte microcytoxicity technique. In: Ray SG Jr, Hare DB, Pedersen PD, Mullaly DI. (eds): NIAID manual of tissue typing tech­niques 1976-77. Washington DC: Government printing office: 1976:22-24. CDHEW publication no (NIH): 76-545.  Back to cited text no. 15      
16.Cho Y, Terasaki PI. Comparison of kidney graft survival in Asian and Caucasian patients transplanted in the United States. Transplant Proc 1996;28(3):1571-3.  Back to cited text no. 16      

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Correspondence Address:
Lakshmi Kiran Chelluri
Transplant Biology and Stem Cell, Global Hospitals, Lakdi-ka-Pool, Hyderabad 500 004 (A.P.)
India
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PMID: 19861859

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]

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    Abstract
    Introduction
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    Statistical Analysis
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