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12 August 2022 : Original article  

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 Mărunţelu12ABCDEF, Claudiu Eduard Nistor ORCID logo2CEF*, Bogdan Mihai Cristea2CE, Corina Andreea Rotarescu12BCD, Andreea Mirela Caragea2B, Maria Tizu2B, Ileana Constantinescu12AD

DOI: 10.12659/AOT.937267

Ann Transplant 2022; 27:e937267

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.

Keywords: Allografts, Graft Rejection, Graft Survival, HLA Antigens, Kidney Transplantation, Tacrolimus

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358