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Article Review/Hyperlink
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Doxiadis IIN, Smits MJA, Schreuder GMTh, Persijn GG, van
Houwelingen HC, van Rood JJ, Claas FHJ
Association between specific HLA combinations and probability
of kidney allograft loss: the taboo concept
Lancet
(Sep) 348:850-853 1996

This paper, using the Eurotransplant database, aims at defining
combinations of specific HLA mismatches in the context of a given HLA
antigen present in the recipient influencing graft survival. To this end,
2877 first cadaveric transplantations with only one HLA mismatch were
identified, and only the HLA antigen mismatches that occured at least 100
times were further studied (1342 transplants for 12 mismatches). 7
combinations of a specific HLA mismatch in the context of a given HLA
antigen in the recipient (e.g. donor mismatched A2 in an B 44 recipient)
were shown to have a statistically significant negative impact on graft
survival, as compared to no-mismatch transplants or other one mismatch
combinations not affecting graft survival.
All patients were grafted between 1982 and 1992, received cyclosporin, and
a multivariate analysis taking into account classical variables such as
cold ischemia time, age, sex, etc. confirmed the effect of these "taboo" HLA
combinations on graft
survival. This negative effect was limited to one HLA haplotype mismatch
and strangely diseappeared with more than one mismatch!
Those "taboo" combinations, resulting in a graft survival of 50% at 5 years
(as compared to 69% for other combinations) occured in 15% of the
transplants.
Comment: These data need to be confirmed using other transplant
databases, as
similar approaches (such as the search for permissible mismatches by
Terazaki) have been shown not to be applicable anywhere else other than in
the
original database.
(Denis Glotz MD, (Hopital Broussais, Paris, France)
The full text of this abstract is available
at the Lancet site. The first time you access the Lancet site, you will need
to register to get a login ID and password. Then you can read the full text
abstract.
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