Transplant Trial Watch

Impact of HLA Mismatching on Early Subclinical Inflammation in Low-Immunological-Risk Kidney Transplant Recipients.

Hernandez, D., et al.

Journal of Clinical Medicine 2021; 10(9): 29.

This study is a part of a randomised controlled trial comparing corticosteroid withdrawal versus standard immunosuppression in low-immunological-risk renal transplantation. The aim of this study was to determine the effect of human leukocyte antigen (HLA)-mismatching on early subclinical inflammation (SCI) in low-immunological-risk renal transplant patients.

Participants in the original trial were randomised to either the prednisone continuation group or the prednisone withdrawal group.

105 Caucasian renal transplant patients.

Association between HLA mismatches and SCI risk.

3 months

CET Conclusions
This paper reports on sub-clinical inflammation in low-risk renal transplantation. It was performed within a trial of corticosteroid withdrawal, and hence the randomisation is not related directly to this paper. Protocol biopsies were performed at 3 months after transplant, during which time no patient had acute rejection or developed de novo DSA. The biopsies showed that 54% of recipients had sub-clinical inflammation (which is in agreement with previous studies). This inflammation was correlated significantly with the absolute number of HLA mismatches, and independently with Class II mismatches in multivariate analysis, but not Class I. At this level of breakdown, however, there is a question of adequate power to make this assessment. In the multivariate analysis, several other factors were assessed and found not to be independent predictors of sub-clinical inflammation: recipient age, DGF, transfusion prior to transplant, and tacrolimus. Subclinical inflammation is present in half of kidney transplants on protocol biopsies and there is evidence from other studies that these changes can lead to chronic damage and dysfunction. The study is limited by its small sample size and ethnic homogeneity (100% Caucasian). It also represents an analysis of results from an RCT, and therefore may show association but has not proven causation and does not have significant or novel implications for clinical practice.

Jadad score

Data analysis
Per protocol analysis

Allocation concealment

Trial registration - NCT02284464

Funding source
Non-industry funded