Background: The human leukocyte antigen (HLA) system plays a crucial role in the activation and function of the immune system. HLA mismatches may lead to activation of alloreactive T-cells and development of donor-specific HLA antibodies (DSA), thereby significantly impairing kidney graft survival.
Methods: From March 1976 and August 2019, a total of 2200 kidney transplant recipients were included in the study.The patients were divided into 3 main groups according to degree of HLA mismatch.
Results:
acute rejection episodes were more frequent with group II and III. Chronic rejection was revealed in graft biopsies of group II and III more than group I . Incidence of post-transplant Hypertension and Diabetes mellitus was higher in group III . Median serum creatinine was higher in group III after 2, 3, 4 and 5 years post transplantation with subsequent lower creatinine clearance .The majority of patients were alive with functioning graft at last follow-up especially in group I . More patients were alive with failed graft at last follow up in group III.. On the other hand the 5, 10 and 15 years graft and patient survival showed statistical significant difference among the 3 groups with better survival for group I.
Conclusions: The degree of mismatch affected the choice of immunosuppressive regimen. Higher HLA mismatch was associated with higher incidence of diabetes and hypertension and lower patient and graft survival.