HLA-A, -B, -C, -DR, and -DQ Matching in Pancreas Transplantation

Effect on Graft Rejection and Survival

E. N. Rudolph, T. B. Dunn, D. Mauer, H. Noreen, D. E R Sutherland, R. Kandaswamy, E. B. Finger

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

To enhance selection of appropriate deceased donors for pancreas transplants, we sought to determine whether HLA matching improved posttransplantation outcomes. In this single-center study of 1219 pancreas transplants, we correlated posttransplantation outcomes with HLA-A, -B, -C, -DR, and -DQ matches and mismatches. Rejection was linearly correlated with the number of mismatches. The individual number of HLA mismatches reached significance at four or more with a 2.3- to 2.9-fold increase in rejection. The effect was most predominant with HLA-B (1.8-fold with one mismatch and 2.0-fold with two mismatches) and -DR (1.9-fold with two mismatches) loci, whereas HLA-A, -C, and -DQ matches or mismatches did not independently predict acute rejection. The affect was strongest in solitary pancreas transplants, with little impact for simultaneous pancreas and kidney (SPK). In contrast, HLA matching did not affect graft or patient survival rates but was associated with a reduced risk of opportunistic infection. Avoidance of acute rejection saved an estimated $32 000 for solitary pancreas recipients and $52 000 for SPK recipients in hospital costs. Our data do not support the use of HLA matching for predicting pancreas graft survival but do support its significance for the reduction of acute rejection, particularly for solitary pancreas recipients.

Original languageEnglish (US)
Pages (from-to)2401-2412
Number of pages12
JournalAmerican Journal of Transplantation
Volume16
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Pancreas Transplantation
HLA-A Antigens
HLA-B Antigens
Graft Rejection
Graft Survival
Pancreas
Transplants
HLA-C Antigens
Kidney
Hospital Costs
Opportunistic Infections
Survival Rate
Rejection (Psychology)
Tissue Donors

Keywords

  • clinical research/practice
  • diabetes: type 1
  • donors and donation
  • histocompatibility
  • major histocompatibility complex (MHC)
  • pancreas/simultaneous pancreas-kidney transplantation
  • rejection
  • risk assessment/risk stratification

PubMed: MeSH publication types

  • Journal Article
  • Clinical Trial

Cite this

HLA-A, -B, -C, -DR, and -DQ Matching in Pancreas Transplantation : Effect on Graft Rejection and Survival. / Rudolph, E. N.; Dunn, T. B.; Mauer, D.; Noreen, H.; Sutherland, D. E R; Kandaswamy, R.; Finger, E. B.

In: American Journal of Transplantation, Vol. 16, No. 8, 01.08.2016, p. 2401-2412.

Research output: Contribution to journalArticle

@article{52eca6bb383f425cb0c2138ddbb5af20,
title = "HLA-A, -B, -C, -DR, and -DQ Matching in Pancreas Transplantation: Effect on Graft Rejection and Survival",
abstract = "To enhance selection of appropriate deceased donors for pancreas transplants, we sought to determine whether HLA matching improved posttransplantation outcomes. In this single-center study of 1219 pancreas transplants, we correlated posttransplantation outcomes with HLA-A, -B, -C, -DR, and -DQ matches and mismatches. Rejection was linearly correlated with the number of mismatches. The individual number of HLA mismatches reached significance at four or more with a 2.3- to 2.9-fold increase in rejection. The effect was most predominant with HLA-B (1.8-fold with one mismatch and 2.0-fold with two mismatches) and -DR (1.9-fold with two mismatches) loci, whereas HLA-A, -C, and -DQ matches or mismatches did not independently predict acute rejection. The affect was strongest in solitary pancreas transplants, with little impact for simultaneous pancreas and kidney (SPK). In contrast, HLA matching did not affect graft or patient survival rates but was associated with a reduced risk of opportunistic infection. Avoidance of acute rejection saved an estimated $32 000 for solitary pancreas recipients and $52 000 for SPK recipients in hospital costs. Our data do not support the use of HLA matching for predicting pancreas graft survival but do support its significance for the reduction of acute rejection, particularly for solitary pancreas recipients.",
keywords = "clinical research/practice, diabetes: type 1, donors and donation, histocompatibility, major histocompatibility complex (MHC), pancreas/simultaneous pancreas-kidney transplantation, rejection, risk assessment/risk stratification",
author = "Rudolph, {E. N.} and Dunn, {T. B.} and D. Mauer and H. Noreen and Sutherland, {D. E R} and R. Kandaswamy and Finger, {E. B.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1111/ajt.13734",
language = "English (US)",
volume = "16",
pages = "2401--2412",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - HLA-A, -B, -C, -DR, and -DQ Matching in Pancreas Transplantation

T2 - Effect on Graft Rejection and Survival

AU - Rudolph, E. N.

AU - Dunn, T. B.

AU - Mauer, D.

AU - Noreen, H.

AU - Sutherland, D. E R

AU - Kandaswamy, R.

AU - Finger, E. B.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - To enhance selection of appropriate deceased donors for pancreas transplants, we sought to determine whether HLA matching improved posttransplantation outcomes. In this single-center study of 1219 pancreas transplants, we correlated posttransplantation outcomes with HLA-A, -B, -C, -DR, and -DQ matches and mismatches. Rejection was linearly correlated with the number of mismatches. The individual number of HLA mismatches reached significance at four or more with a 2.3- to 2.9-fold increase in rejection. The effect was most predominant with HLA-B (1.8-fold with one mismatch and 2.0-fold with two mismatches) and -DR (1.9-fold with two mismatches) loci, whereas HLA-A, -C, and -DQ matches or mismatches did not independently predict acute rejection. The affect was strongest in solitary pancreas transplants, with little impact for simultaneous pancreas and kidney (SPK). In contrast, HLA matching did not affect graft or patient survival rates but was associated with a reduced risk of opportunistic infection. Avoidance of acute rejection saved an estimated $32 000 for solitary pancreas recipients and $52 000 for SPK recipients in hospital costs. Our data do not support the use of HLA matching for predicting pancreas graft survival but do support its significance for the reduction of acute rejection, particularly for solitary pancreas recipients.

AB - To enhance selection of appropriate deceased donors for pancreas transplants, we sought to determine whether HLA matching improved posttransplantation outcomes. In this single-center study of 1219 pancreas transplants, we correlated posttransplantation outcomes with HLA-A, -B, -C, -DR, and -DQ matches and mismatches. Rejection was linearly correlated with the number of mismatches. The individual number of HLA mismatches reached significance at four or more with a 2.3- to 2.9-fold increase in rejection. The effect was most predominant with HLA-B (1.8-fold with one mismatch and 2.0-fold with two mismatches) and -DR (1.9-fold with two mismatches) loci, whereas HLA-A, -C, and -DQ matches or mismatches did not independently predict acute rejection. The affect was strongest in solitary pancreas transplants, with little impact for simultaneous pancreas and kidney (SPK). In contrast, HLA matching did not affect graft or patient survival rates but was associated with a reduced risk of opportunistic infection. Avoidance of acute rejection saved an estimated $32 000 for solitary pancreas recipients and $52 000 for SPK recipients in hospital costs. Our data do not support the use of HLA matching for predicting pancreas graft survival but do support its significance for the reduction of acute rejection, particularly for solitary pancreas recipients.

KW - clinical research/practice

KW - diabetes: type 1

KW - donors and donation

KW - histocompatibility

KW - major histocompatibility complex (MHC)

KW - pancreas/simultaneous pancreas-kidney transplantation

KW - rejection

KW - risk assessment/risk stratification

UR - http://www.scopus.com/inward/record.url?scp=84978902153&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978902153&partnerID=8YFLogxK

U2 - 10.1111/ajt.13734

DO - 10.1111/ajt.13734

M3 - Article

VL - 16

SP - 2401

EP - 2412

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 8

ER -