In this interesting analysis from the Collaborative Transplant Study the authors have analysed some 180,000 deceased donor kidney transplants performed between 1990 and 2009 and have found that the incidence of death with a functioning graft was 4.8% during the first year after transplant and 7.7% during years 2-5. The most frequent causes of death with a functioning graft were infection, cardiovascular disease and malignancy, the first two being most common in the first year while in the later years cardiovascular disease and malignancy were the more common causes of death. Death with a functioning graft was associated with HLA-A plus B plus DR mismatches, but in fact this correlation was greater with HLA class 2 mismatches than for class 1 mismatches. The HLA mismatches were associated with death with a functioning graft because of infection or cardiovascular disease but not malignancy. Thus we seem to have another influence of HLA matching other than graft rejection or graft function.
Was this analysis corrected for immunosuppression? Presumably more of the higher mismatched patients would have been on more intensive/steroid containing regimens, which would explain the increased infection and cardiovascular risk?