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#17
NON-HLA: A POTENTIAL CAUSE FOR REJECTION IN RENAL TRANSPLANTATION.
Jody Jennemann, MT(ASCP), Donna L. Phelan, CHS(ABHI), Connie Ceriotti, Andres Jaramillo, Ph.D, William Chapman, M.D. and T. Mohanakumar, Ph.D.. Barnes-Jewish Hospital HLA Laboratory and St. Louis MO, Washington University, Dept of Surgery.

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In order to determine the role of non-HLA antigens in renal transplant rejection, we analyzed the outcome of 6 antigen HLA matched and 0 antigen HLA mismatched transplants, both in our center as well as in the nation. The graft survival rate was determined in 1,254 transplants done in our center between 1993 and 2003 with7% having 6 HLA matches and 3% having 0 HLA mismatches. Rejection in the group with 0 HLA mismatches was 9.5%, while the group with ≥ 1 HLA mismatch had a rejection rate of 23.6%(P=0.0009). Fifteen percent of the 0 HLA mismatched patients lost their graft while in the group with ≥ 1 HLA mismatch 11.8% lost their graft(P<0.0001). During the same time period, national data showed, out of a total of 90,776 total transplants, 21.3% 0 HLA mismatched grafts were lost compared to 32.2% in the group with ≥ 1 HLA mismatch(P<0.0001). Taken together these results demonstrate that rejection as well as graft losses are common occurrences in 0 HLA mismatched renal transplants both in our center as well as in the nation. Possible reasons for this include the role of non-HLA antibodies and the effect of minor Histocompatibility antigens indicating the need for further investigation.