The effect of recurrent glomerulonephritis and acute rejection episodes in zero human leukocyte antigen-mismatched kidney transplantation.

Background. Although human leukocyte antigen (HLA)-identical renal transplantation achieves superior graft outcomes, it does not uniformly allow indefinite graft survival. Recurrence of the original disease and effects of acute rejection episodes (ARE) may preclude indefinite survival. Herein, we have analyzed the factors that affect the graft outcomes among HLA zero-mismatch cases. Methods. We performed a retrospective, single-center study to evaluate the effect of recurrent glomerulonephritis (GN) and ARE on outcomes of grafts with zero HLA-mismatches (n = 122) versus three to four mismatches (n = 317), and five to six mismatches (n = 102). Forty-one percent of patients had GN as underlying disease. Results. Overall graft survival was 92.4% at 5 years and 79.6% at 10 years. HLA incompatibility did not affect graft survival: zero versus three to four versus five to six mismatches = 92.8% versus 90.8% versus 95.8% at 5 years and 82.5% versus 74.3% versus 85.1% at 10 years, respectively (P = .399). Subgroup analysis for subjects with GN revealed that ARE (P = .001) and recurrent GN (P = .003) were the risk factors for graft loss, whereas living donation was protective (P = .029). ARE was more prevalent with greater HLA incompatibility [0 (reference) < three to four < five to six mismatches; P = .047 and P = .014]. However, recurrent GN showed the opposite trend [0 (reference) > three to four > five to six mismatches; P = .106 and P = .022]. Furthermore, graft loss due to recurrent GN was significant among the HLA zero versus the three- to four-mismatch group (P = .047). Conclusions. Graft survival was not affected by the degree of HLA incompatibility, which was mainly due to the recurrence of underlying disease. Therefore, a main focus should be the management of recurrence, especially among HLA-identical kidney transplantations.