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Khirurgii

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Year 2020 Vol. 28 No 3

TRANSPLANTOLOGY

A.V. VATAZIN, A.B. ZULKARNAEV, V.A. STEPANOV

A PERSPECTIVE APPROACH TO THE TISSUE COMPATIBILITY ASSESSMENT OF A DONOR AND A RECIPIENT DURING CADAVERIC KIDNEY TRANSPLANTATION

Moscow Regional Research Clinical Institute named after M.F. Vladimirskiy, Moscow,
The Russian Federation

Objective. To perform a multiple factor analysis of the impact of the epitope mismatche number on the renal transplant survival.
Methods. An observational retrospective cohort study including 824 adult kidney graft recipients was performed.
Results. All recipient donor pairs had human leukocyte antigen mismatches. Significant risk factors for graft loss in the preassigned multivariate model were as follows: HLA MM (1 – HR 1; 2– HR 1.24 [95% confidence interval – 95% CI 0.7; 2.15], p=0.344; 3 – HR 1 , 48 [95% CI 0.86; 2.33], p=0.251; 4 – HR 1.88 [95% CI 1.32; 2.52], p<0.001; 5 – HR 2.41 [95 % CI 2; 2.93], p<0.001; 6 – HR 2.98 [95% CI 2.59; 3.46], p<0.001) p<0.001; duration of HR conservation 1.08 per hour [95% CI 1.02; 1.16], p=0.01; panel-reactive antibodies value (PRA) HR 1.24 per every 10% [95% CI 1.06; 1.58], p=0.01; but not the type of donor, age and gender of the recipient.
When including the epitope mismatches (EpMM) in the model, significant risk factors were: EpMM (<10– HR 1; 10-19– HR 1.71 [95% CI 1.09; 2.49], p=0.021; 20-29 – HR 2,11 [95% CI 1.59; 2.68], p<0.001; 30-39 – HR 2.4 [95% CI 1.96; 2.86], p<0.001; 40-49 – HR 2 , 59 [95% CI 2.17; 3.04], p<0.001; ≥50 – HR 2.71 [95% CI 2.31; 3.15], p<0.001) p<0.001; PRA HR 1.18 for every 10% [95% CI 1.09; 1.5], p=0.007; but not the duration of conservation, donor type, age and gender of the recipient. However, HLA MM was no longer a significant risk factor for HR graft loss 1.19 [95% CI 0.88; 1.55], p=0.451
Conclusions. The number of epitope mismatches between donor phenotype and recipient phenotype remains an important factor in long-term graft survival, even in despite of some corrections of the number of HLA mismatches, the donor type and the level of pre-sensitization of the recipient.

Keywords: kidney transplantation, HLA, epitope, eplet, tissue compatibility, recipient selection
p. 268-275 of the original issue
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Address for correspondence:
129110, Russian Federation,
Moscow, Schepkin str., 61/2, 6,
Moscow Regional Research Clinical Institute
Named after M.F. Vladimirskiy,
the Surgical Department of Kidney Transplantation,
tel. mobile +7-916-705-98-99,
e-mail:7059899@gmail.com,
Zulkarnaev Alexey B.
Information about the authors:
Vatazin Andrey V., MD, Professor, Chief Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research Clinical Institute Named after M.F. Vladimirskiy, Moscow, the Russian Federation.
http://orcid.org/0000-0001-8497-0693
Zulkarnaev Alexey B., MD, Associate Professor, Leading Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research Clinical Institute Named after M.F. Vladimirskiy, Moscow, Russian Federation.
http://orcid.org/0000-0001-5405-7887
Stepanov Vadim A., PhD, Senior Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research Clinical Institute Named after M.F. Vladimirskiy, Moscow, Russian Federation.
http://orcid.org/0000-0002-0881-0599
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