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The Synergistic Effect of Class II HLA Epitope-Mismatch and Nonadherence on Acute Rejection and Graft Survival.

Authors :
Wiebe C
Nevins TE
Robiner WN
Thomas W
Matas AJ
Nickerson PW
Source :
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2015 Aug; Vol. 15 (8), pp. 2197-202. Date of Electronic Publication: 2015 Jun 11.
Publication Year :
2015

Abstract

Predicting long-term outcomes in renal transplant recipients is essential to optimize medical therapy and determine the frequency of posttransplant histologic and serologic monitoring. Nonadherence and human leukocyte antigen (HLA) mismatch are risk factors that have been associated with poor long-term outcomes and may help individualize care. In the present study, class II HLA mismatches were determined at the HLA epitope level in 195 renal transplant recipients in whom medication adherence was prospectively measured using electronic monitors in medication vial caps. Recipients were grouped by medication adherence and high (≥10 HLA-DR, ≥17 HLA-DQ) or low epitope-mismatch load. We found that the combination of higher epitope mismatch and poor adherence acted synergistically to determine the risk of rejection or graft loss. Nonadherent recipients with HLA-DR epitope mismatch ≥10 had increased graft loss (35% vs. 8%, p < 0.01) compared to adherent recipients with low epitope mismatch. At the HLA-DQ locus nonadherent recipients with HLA-DQ epitope mismatch ≥17 had increased graft loss (33% vs. 10%, p < 0.01) compared to adherent recipients with low epitope mismatch. Subclinical nonadherence early posttransplant combined with HLA class II epitope mismatch may help identify recipients that could benefit from increased clinical, histologic, and serologic monitoring.<br /> (© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Details

Language :
English
ISSN :
1600-6143
Volume :
15
Issue :
8
Database :
MEDLINE
Journal :
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Publication Type :
Academic Journal
Accession number :
26095765
Full Text :
https://doi.org/10.1111/ajt.13341