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. 2022 Aug 12:27:e937267.
doi: 10.12659/AOT.937267.

Retrospective Study from a Single Center in Romania of 347 Renal Transplant Patients Treated with Tacrolimus, Mycophenolate, and Steroids to Evaluate the Association Between Anti-HLA Antibodies and 5-Year Graft Survival

Ion Mărunţelu  1   2 , Claudiu Eduard Nistor  2 , Bogdan Mihai Cristea  2 , Corina Andreea Rotarescu  1   2 , Andreea Mirela Caragea  2 , Maria Tizu  2 , Ileana Constantinescu  1   2
Affiliations

Retrospective Study from a Single Center in Romania of 347 Renal Transplant Patients Treated with Tacrolimus, Mycophenolate, and Steroids to Evaluate the Association Between Anti-HLA Antibodies and 5-Year Graft Survival

Ion Mărunţelu et al. Ann Transplant. .

Abstract

BACKGROUND Kidney transplantation is the most recommended treatment in chronic kidney disease. The recipient's immune system reacts to a kidney graft as to an alloantigen by producing antibodies (anti-human leukocyte antigens [HLAs]). Although immunosuppressive therapy is used to overcome this problem, the long-term survival of a kidney graft after 5 years remains low. This retrospective study from a single center in Romania of 347 renal transplant patients treated with tacrolimus, mycophenolate, and steroids aimed to evaluate the association between anti-HLA antibodies and 5-year graft survival. MATERIAL AND METHODS Anti-HLA antibodies were screened and identified using the Luminex method, while tacrolimus levels were monitored using the chemiluminescent assay. RESULTS Twenty-seven patients had pre-existing anti-HLA antibodies, while 320 patients did not. Of the 320 patients, 15% developed anti-HLA antibodies following kidney transplantation. The intrapatient minimum blood level of tacrolimus (cut-off value: 4.6 ng/mL) after transplantation was significantly associated with the risk of de novo anti-HLA antibodies (P<0.001). In patients with or without de novo anti-HLA antibodies, the 5-year allograft survival rate was 77.1% vs 90.8% (P=0.004). After Bonferroni correction, donor age (P=0.001), and donor type (P<0.0001) were statistically associated with the risk of allograft rejection. CONCLUSIONS This study showed that anti-HLA antibodies at 5 years after kidney transplantation were significantly associated with graft failure. The findings support previous studies and indicate that monitoring of anti-HLA antibodies should be considered in patients with renal transplant.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Cut-off value for the appearance of de novo human leucocyte antigen (HLA) antibodies.
Figure 2
Figure 2
Area under curve (AUC). Because P value is less than 0.05, the area under the receiver operating characteristic (ROC) curve is substantially different from 0.5, implying that the laboratory test has the capacity to identify patients at risk to develop human leucocyte antigen (HLA) antibodies.
Figure 3
Figure 3
The survival graft rates in patients without preformed anti-human leucocyte antigen (HLA) antibodies.
Figure 4
Figure 4
_Survivals rate according to status of human leucocyte antigen (HLA) immunization before kidney transplantation.
See this image and copyright information in PMC

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