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논문분류	춘계학술대회 초록집
제목	HLA-incompatible Kidney Transplantation Showed Similar Outcomes Compared To HLA-compatible Kidney Transplantation After An Early Rejection
저자	YOON JU KIM
출판정보	2024; 2024(1):
키워드
초록	Objectives: HLA-incompatible (HLA-i) kidney transplantation (KT) constitutes a high-risk group with an increased risk of rejection and graft failure. We investigated the differences in short- and long-term outcomes of HLA-i KT compared to HLA-compatible (HLA-c) KT. Methods: Patients with living donor KT were enrolled from a prospective nationwide cohort in Korea. HLA-i KT was defined as a desensitized transplantation with complement-dependent cytotoxicity (CDC) or flow-cytometric (FCM) crossmatch positivity. The primary outcome was a composite of acute rejection, graft failure, and patient death. The association between acute rejection and HLA types was analyzed. Tacrolimus trough levels were compared between HLA-i and HLA-c KT groups. Results: A total of 3692 KT recipients were enrolled and 466 (12.6%) patients received HLA-i KT. Kaplan-Meier curve revealed that HLA-i KT showed higher acute rejection, graft failure, and the composite than HLA-c KT (all P < 0.05). The HLA-i group is associated with a higher risk of the composite (adjusted hazard ratio [aHR] 1.57; 95% confidence interval [CI] 1.34-1.79; P < 0.001) and acute rejection (aHR 1.56; 95% CI 1.37-2.88; P < 0.001) than the HLA-c group during the 1st year after KT. However, 1 year after KT, all the transplant outcomes did not differ between the two groups. Logistic regression analysis showed that antibodies against HLA-DR were significantly associated with an increased risk of acute rejection (OR 1.93; 95% CI 1.14-3.28; P = 0.015). Tacrolimus trough levels of the HLA-i and HLA-c groups showed no difference at 1 year after KT (6.3±2.2 vs. 6.4±2.3 ng/mL, respectively) and thereafter. Conclusions: HLA-i KT showed worse transplant outcomes until 1 year after transplantation. However, HLA-i KT after the early period had non-inferior graft and patient survival results compared to HLA-c KT.
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