HLA‐identical living related kidney transplantation: Outcomes of a national multicenter study

• Published in: International journal of urology 2022-06, Vol.29 (6), p.519-524
• Main Authors: Bentata, Yassamine, ElKabbaj, Driss, Bahadi, Abdelaali, Rhou, Hakima, Laouad, Inass, Sqalli, Tarik, Bouattar, Tarik, Ouzeddoun, Naima, Bayahia, Rabia, Ramdani, Benyouns
• Format: Article
• Language: English
• Subjects: acute rejection; Adult; Biopsy; Donors; Female; Graft rejection; Graft Rejection - epidemiology; Graft Survival; Histocompatibility antigen HLA; HLA Antigens; HLA‐identical; Humans; Immunosuppressive agents; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; living donor; Living Donors; Male; Medical prognosis; Patients; Registries; Retrospective Studies; transplant survival; Twins; Young Adult
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.14827

Objectives The kidney prognosis of HLA‐identical seems theoretically very interesting with the lowest risk of acute rejection after that of identical twins. Objectives were to determine the prevalence of acute rejection and various complications in a cohort of HLA‐identical living‐related kidney transplant. Methods A retrospective, multicenter study was conducted in seven university centers in Morocco, which included all recipients of an HLA‐identical living‐related kidney transplant performed between 1990 and 2019. Results Data on 68 HLA‐identical living‐related kidney transplants were collected. The donors were siblings in 89.7%, the parents in 7.3%, and identical twins in 3% of cases. 53.6% of all recipients were under 35 years old, and 59.4% of them were male. 39.7% of all donors were under 35 years old, and 47% of them were male. 48.5% of HLA‐identical living‐related kidney transplants were performed before the year 2000. 18 kidney transplant biopsies were performed on 16 kidney transplant recipients. Seven episodes of acute rejection occurred in six patients, 8.8% of the whole cohort (n = 68). Two cases of acute rejection among the seven were related to poor adherence, cessation of immunosuppressive therapy, and loss of medical follow‐up by these patients. These two patients were 20 years old at the time of kidney transplantation. The global kidney transplant survival was 66.7% versus 91.9% (P = 0.04) in the two patient groups having developed acute rejection and not having developed acute rejection, respectively. Conclusions Acute rejection is a real threat to HLA‐identical kidney transplant recipients. Therefore, it seems very important to codify the immunosuppressive regimen and to adopt a minimal and effective treatment.