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Genetic mismatches linked to kidney transplant failure

A successful organ transplant depends in part on preventing tissue rejection. How closely tissues match between recipient and donor can influence the transplant’s outcome. In an analysis of kidney transplant data from 1987 to 2013, an NIDDK-led team found that each mismatched pair of tissue proteins increased the risk of failure – indicated by the kidney recipient returning to dialysis – by 13 percent. The team evaluated 189,141 first-time adult transplants in the United States from deceased donors. Researchers obtained the information from the United Network for Organ Sharing. Results were published in Transplantation.

Human leucocyte antigen (HLA) matching is a genetic technique that tests the compatibility of pairs of proteins to determine how closely the tissue of one person matches the tissue of another. The importance of being HLA-matched, relative to factors such as recipient age and ethnicity that also affect transplant outcomes, has been debated for many years. Newer anti-rejection drugs have somewhat overcome the consequences of tissue mismatch, though they do not remove the need for good genetic matching.

The study reinforces the value of HLA matching for kidneys from deceased donors. Though more research is needed, the findings suggest that closer matching could enhance long-term survival of transplanted kidneys in the United States, potentially delaying or eliminating the need to resume dialysis.

Now that the investigators have looked at the survival of kidneys from deceased donors, they plan to apply the same analytical methods to transplants from living donors.


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