Effects of HLA type, PRA and DSA levels on graft survival, rejection and mortality in renal transplantation recipients

Aim: The aim of this study was to determine the HLA antigen profiles of patients undergoing renal transplantation and to determine which HLA type will play a more important role in influencing the outcome of transplantation. Material and Method: Between 2012 and 2020, 65 patients who received kidney transplantation at Dicle University Hospital were included. Demographic characteristics, transplant type, baseline and 1-year post-transplant laboratory data, rejection and graft loss were retrospectively analyzed. HLA tissue typing, PRA and DSA results of the recipients were recorded. Factors affecting rejection were analyzed. Results: 84.6% of the transplants were from living donors and 15.4% from cadaveric donors. Improvement in hemoglobin, glucose, urea, creatinine, albumin, phosphorus, PTH, HDL levels were detected in the 1st year after transplantation. DSA was negative in all transplanted patients. PRA was positive in 2 patients. Of 65 patients, 72.3% did not develop rejection and 27.7% developed rejection. 8 of the patients died. The most frequent alleles were HLA-A03, HLA-A24 and HLA-A02 in the HLA-A group, HLA-B35, HLA-B51 and HLA-B07 in the HLA-B group, HLA-DR11, HLA-DR03 and HLA-DR04 in the HLA-DR group, HLA-DQ03, HLA-DQ05 and HLA-DQ06 in the HLA-DQ group, respectively. While HLA-A and HLA-B subtypes were not associated with rejection, only HLA-DR13 (p:0.029) and HLA-DQ06 (p:0.013) were significantly associated with rejection. In the sub-analysis of HLA groups, when patients with 0 match were compared with those with 2 matches, rejection was found to be higher in patients with 0 matches. Donor age was higher in patients with rejection. Rejection was detected in PRA positive patients and in 7 of 8 patients who died. Conclusion: HLA compatibility, PRA positivity and donor age are important factors affecting rejection. We observed that the risk of rejection and graft loss increased with increasing HLA incompatibility. We also found that the frequency of rejection increased in patients with HLA-DR13 and HLA-DQ06 alleles.