SURPRISINGLY STRONG HLA MATCHING EFFECT IN NONSENSITIZED KIDNEY GRAFT RECIPIENTS WITH HIGH PRETRANSPLANT SOLUBLE CD30.

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SURPRISINGLY STRONG HLA MATCHING EFFECT IN NONSENSITIZED KIDNEY GRAFT RECIPIENTS WITH HIGH PRETRANSPLANT SOLUBLE CD30.
Caner Suesal M.D. , Steffen Pelzl M.D. and Gerhard Opelz M.D. for the Collaborative Transplant Study . Heidelberg Germany, Institute of Immunology, University of Heidelberg, D-69120, Department of Transplantation Immunology .

The influence of HLA matching on graft survival is stronger in patients with preformed lymphocytotoxic antibodies than in nonsensitized patients. Recently, we demonstrated that pre-transplant (pre-Tx) sCD30 is an excellent predictor of long-term graft outcome independent of pre-Tx antibody status. In the present study we analyzed the impact of HLA compatibility on kidney transplant survival in 3980 nonsensitized (PRA<10%) first cadaver kidney recipients in relation to pre-Tx serum sCD30 content. Serum sCD30 content was determined using a commercial ELISA. While the influence of HLA compatibility (0-6 HLA-ABDR mismatches) on graft outcome was rather unimpressive in nonsensitized recipients with a low sCD30 (regression at 3 years p=0.01; at 5 years p=0.10), the effect was very strong in nonsensitized patients with a high pre-Tx sCD30 (at 3 years p<0.0001; at 5 years p=0.0001). To ascertain the absence of clinically relevant preformed antibodies in the nonsensitized group, we performed a separate analysis in the subset of patients who were anti-HLA class I/II-ELISA-negative. Among patients with high pre-Tx sCD30, the survival difference between relatively well (≤3) or poorly matched (>3 HLA-ABDR mismatches) grafts was strong (71±2% vs. 52±4% at 5 years, p<0.0001) whereas it was weak in patients with a low sCD30 (p=0.08). Our data show an unexpectedly strong HLA effect in nonsensitized recipients with high pre-Tx serum sCD30. Similar to presensitized patients with high PRA, nonsensitized patients with high pre-Tx sCD30 appear to benefit greatly from an HLA well-matched kidney. Patients should be tested for sCD30 while on the waiting list for a kidney transplant and HLA well-matched kidneys should be allocated to patients with high sCD30.