Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany.
Transplantation. 2010 Aug 15;90(3):292-7. doi: 10.1097/TP.0b013e3181e46a22.
The impact and relationship of donor age, human leukocyte antigen (HLA) matching, and posttransplant non-Hodgkin lymphoma in pediatric kidney recipients are not completely understood.
We analyzed Collaborative Transplant Study data from 9209 pediatric kidney transplant recipients to examine the effects of donor age and HLA match on graft survival and the relationship between HLA match and occurrence of non-Hodgkin lymphoma.
Survival rates using donors aged 11 to 17, 18 to 34, or 35 to 49 years were similar. Cox regression analysis showed that two HLA-DR mismatches were associated with lower graft survival in transplants performed during 1988 to 1997 (P<0.001) but not during the 1998 to 2007 period (P=0.95). A hierarchical relationship was observed for the effect of increasing numbers of combined HLA-A+B+DR mismatches on graft survival during the 1988 to 1997 (P<0.001) and the 1998 to 2007 period (P<0.001). An association between two HLA-DR mismatches and non-Hodgkin lymphoma was demonstrated by multivariate analysis (hazard ratio for 2 vs. 0-1 DR mismatches 2.04, P=0.021), and the result was consistent during both 10-year periods.
We recommend that (1) kidneys from deceased donors up to 49 years be allocated to children, (2) an acceptable HLA-A+B+DR match be attempted in patients with relatively common HLA phenotypes, and (3) transplants with two HLA-DR mismatches be avoided to reduce the risk of posttransplant non-Hodgkin lymphoma.
供者年龄、人类白细胞抗原（HLA）配型和移植后非霍奇金淋巴瘤（NHL）对儿科肾移植受者的影响和关系尚未完全阐明。
我们分析了 9209 例儿科肾移植受者的协作移植研究数据，以研究供者年龄和 HLA 配型对移植物存活率的影响，以及 HLA 配型与 NHL 发生之间的关系。
使用 11-17 岁、18-34 岁或 35-49 岁供者的存活率相似。Cox 回归分析显示，在 1988 年至 1997 年期间进行的移植中，两个 HLA-DR 错配与移植物存活率降低相关（P<0.001），但在 1998 年至 2007 年期间无相关性（P=0.95）。在 1988 年至 1997 年（P<0.001）和 1998 年至 2007 年（P<0.001）期间，观察到随着 HLA-A+B+DR 错配数量的增加，对移植物存活率的影响呈等级关系。多变量分析显示，两个 HLA-DR 错配与 NHL 之间存在相关性（2 对 0-1 个 DR 错配的风险比为 2.04，P=0.021），且在两个 10 年期间结果一致。
我们建议（1）将 49 岁以下的已故供者的肾脏分配给儿童，（2）在具有相对常见 HLA 表型的患者中尝试可接受的 HLA-A+B+DR 配型，（3）避免 HLA-DR 错配两个的移植，以降低移植后 NHL 的风险。
