Histocompatibility Testing Predicts Acute Rejection Risk in Early Corticosteroid Withdrawal Regimens

• Published in: Transplantation proceedings Vol. 37; no. 2; pp. 809 - 811
• Main Authors: Woodle, E.S., Susskind, B., Alloway, R.R., Hanaway, M.J., Thomas, M., Buell, J., Alexander, J.W., Roy-Chaudhury, P., Succop, P., Cardi, M., Boardman, R., Rogers, C.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2005; Elsevier Science
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Biological and medical sciences; Drug Administration Schedule; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - epidemiology; Graft Rejection - immunology; Graft Rejection - mortality; Graft Rejection - pathology; Histocompatibility Testing - methods; Humans; Immunosuppression - methods; Isoantibodies - blood; Medical sciences; Multivariate Analysis; Regression Analysis; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Time Factors; Tissue, organ and graft immunology; Corticosteroid; Graft(material); Acute; Prediction; Risk; Transplantation; Medical screening; Medicine; Rejection; Treatment; Surgery; Treatment withdrawal; Risk factor; Graft; Early; Predictive factor; Histocompatibility
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.01.061

Histocompatibility testing has been shown to predict acute rejection risk in steroid-based immunosuppression. However, little evidence exists of its ability to predict acute rejection risk in corticosteroid-free patients, with no evidence in early corticosteroid withdrawal (CSWD) under modern immunosuppression. The purpose of this study was to evaluate the ability of histocompatibility testing to identify patients at high risk for acute rejection after early CSWD.
One hundred eighty-one patients were entered into six IRB-approved early CSWD regimens. Histocompatibility testing included serologic PRA, flow cytometric PRA testing by Class I and Class II MHC beads, and B cell crossmatching with pronase treatment. All rejection episodes were biopsy proven, and grading was assigned using Banff criteria. Influence of individual tests was examined using Chi square univariate and multivariate logistic regression analysis.
Median follow-up was 23.5 months (range 7–48 months). Of 181 patients, 16% were repeat transplant recipients, 36% received deceased donor renal transplants, 48% received living related donor renal transplants, and 16% received living unrelated transplants. Overall patient survival was 97%, and death-censored graft survival was 96.5%. Acute rejection rates in the entire follow-up period were 17.7%. 12.4% in primary transplant recipients and 37% in repeat transplant recipients. Multivariate analysis revealed that HLA AB and DR locus mismatching were associated with increased acute rejection risk. Similarly, serologic PRA analysis predicted acute rejection risk; however, flow cytometry crossmatching did not predict acute rejection risk. The greatest single influence on acute rejection risk appeared to be a flow cytometric B cell crossmatch (7.94-fold increased risk). In conclusion, histocompatibility testing can identify patients at high risk for acute rejection following early CSWD. HLA matching, serologic PRA testing, and flow cytometry-based B cell crossmatching can all be used to predict acute rejection risk.