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What is the impact of human leukocyte antigen mismatching on graft survival and mortality in renal transplantation? A meta-analysis of 23 cohort studies involving 486,608 recipients #MMPMID29776389
Shi X; Lv J; Han W; Zhong X; Xie X; Su B; Ding J
BMC Nephrol 2018[]; 19 (ä): ä PMID29776389show ga
Background: The magnitude effects of human leukocyte antigen (HLA) mismatching on post-transplant outcomes of kidney transplantation remain controversial. We aim to quantitatively assess the associations of HLA mismatching with graft survival and mortality in adult kidney transplantation. Methods: We searched PubMed, EMBASE and the Cochrane Library from their inception to December, 2016. Priori clinical outcomes were overall graft failure, death-censored graft failure and all-cause mortality. Results: A total of 23 cohort studies covering 486,608 recipients were selected. HLA per mismatch was significant associated with increased risks of overall graft failure (hazard ratio (HR), 1.06; 95% confidence interval (CI), 1.05?1.07), death-censored graft failure (HR: 1.09; 95% CI 1.06?1.12) and all-cause mortality (HR: 1.04; 95% CI: 1.02?1.07). Besides, HLA-DR mismatches were significant associated with worse overall graft survival (HR: 1.12, 95% CI: 1.05?1.21). For HLA-A locus, the association was insignificant (HR: 1.06; 95% CI: 0.98?1.14). We observed no significant association between HLA-B locus and overall graft failure (HR: 1.01; 95% CI: 0.90?1.15). In subgroup analyses, we found recipient sample size and ethnicity maybe the potential sources of heterogeneity. Conclusions: HLA mismatching was still a critical prognostic factor that affects graft and recipient survival. HLA-DR mismatching has a substantial impact on recipient?s graft survival. HLA-A mismatching has minor but insignificant impact on graft survival outcomes. Electronic supplementary material: The online version of this article (10.1186/s12882-018-0908-3) contains supplementary material, which is available to authorized users.