HDCN Article Review/Hyperlink

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)

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