ArticleJournal of the American Society of Nephrology : JASN2016
Re-Examining Risk of Repeated HLA Mismatch in Kidney Transplantation.
Article in Journal of the American Society of Nephrology : JASN, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 42 citations in OpenAlex.
- Outcomes at 3 years posttransplant in imlifidase-desensitized kidney transplant patients.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2021Trial
- First Transplant Factors and the Influence on Kidney Retransplant Outcomes.Kidney medicine · 2026Article
- Racial and immunologic disparities impact access to kidney rewaitlisting and retransplantation.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2026Article
- Graft survival and rejection with repeated human leukocyte antigen (HLA) mismatch in kidney transplantation: a retrospective multicentre cohort study protocol.BMC nephrology · 2026Article
- Impact of HLA evolutionary divergence and donor-recipient molecular mismatches on antibody-mediated rejection of kidney allografts.Nature communications · 2025Article
- Article
- Early Donor-Specific HLA Antibodies Detected by Screening in the First Month Posttransplant and Kidney Graft Outcomes.Transplant international : official journal of the European Society for Organ Transplantation · 2025Article
- Donor-Specific Antibodies Targeting a Repeated Eplet Mismatch and Outcome After Kidney Retransplantation.Transplant international : official journal of the European Society for Organ Transplantation · 2024Article
- Antibody-mediated rejection: prevention, monitoring and treatment dilemmas.Current opinion in organ transplantation · 2022Review
- Strategies to Overcome HLA Sensitization and Improve Access to Retransplantation after Kidney Graft Loss.Journal of clinical medicine · 2022Review
- The detrimental effect of donor-specific antibodies is irrespective of its level in highly-immunized living donor kidney transplant recipients: A case-control series.Frontiers in immunology · 2022Article
- Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival.Journal of transplantation · 2022Article
- Humanized Mouse Model as a Novel Approach in the Assessment of Human Allogeneic Responses in Organ Transplantation.Frontiers in immunology · 2021Article
- Does HLA matching matter in the modern era of renal transplantation?Pediatric nephrology (Berlin, Germany) · 2021Review
- Management of chronic renal allograft dysfunction and when to re-transplant.Pediatric nephrology (Berlin, Germany) · 2019Review
- Benchmarking the HLA typing performance of Polysolver and Optitype in 50 Danish parental trios.BMC bioinformatics · 2018Article
- HLA Mismatching Strategies for Solid Organ Transplantation - A Balancing Act.Frontiers in immunology · 2016Review
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Kidney retransplantation is a risk factor for decreased allograft survival. Repeated mismatched HLA antigens between first and second transplant may be a stimulus for immune memory responses and increased risk of alloimmune damage to the second allograft. Historical data identified a role of repeated HLA mismatches in allograft loss. However, evolution of HLA testing methods and a modern transplant era necessitate re-examination of this role to more accurately risk-stratify recipients. We conducted a contemporary registry analysis of data from 13,789 patients who received a second kidney transplant from 1995 to 2011, of which 3868 had one or more repeated mismatches. Multivariable Cox proportional hazards modeling revealed no effect of repeated mismatches on all-cause or death-censored graft loss. Analysis of predefined subgroups, however, showed that any class 2 repeated mismatch increased the hazard of death-censored graft loss, particularly in patients with detectable panel-reactive antibody before second transplant (hazard ratio [HR], 1.15; 95% confidence interval [95% CI], 1.02 to 1.29). Furthermore, in those who had nephrectomy of the first allograft, class 2 repeated mismatches specifically associated with all-cause (HR, 1.30; 95% CI, 1.07 to 1.58) and death-censored graft loss (HR, 1.41; 95% CI, 1.12 to 1.78). These updated data redefine the effect of repeated mismatches in retransplantation and challenge the paradigm that repeated mismatches in isolation confer increased immunologic risk. We also defined clear recipient categories for which repeated mismatches may be of greater concern in a contemporary cohort. Additional studies are needed to determine appropriate interventions for these recipients.
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