Graft survival and rejection with repeated human leukocyte antigen (HLA) mismatch in kidney transplantation: a retrospective multicentre cohort study protocol
Year: 2026
Type: article
Study design: Study Protocol
Abstract: BACKGROUND: Candidates awaiting repeat kidney transplantation face substantial immunological barriers due to prior human leukocyte antigen (HLA) allo-sensitisation. Re-exposure to previously mismatched HLA antigens may increase the risk of acute rejection and premature graft loss. Although avoidance of repeat HLA mismatches (RMM) has been standard practice, emerging evidence suggests this risk varies according to the specific HLA allelic RMM and anti-HLA antibody profile to the RMM. Here we describe the protocol for a retrospective registry-based cohort study that aims to determine the differences in graft outcome between recipients who received kidney transplants with and without RMM, and to examine the immunogenicity of RMM that are associated with allo-sensitisation. METHODS: Using linked data between the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australian organ waitlisting and matching system (2012-2023), we will evaluate the association between Class I and II HLA RMM and the risk of acute rejection and graft loss using Cox regression and competing risk models in recipients who have received repeat kidney transplants in Australia. Epitope analysis of each RMM will be examined. DISCUSSION: This study will improve understanding of the impact of RMM on kidney transplant outcomes and identify higher immunological risk RMM associated with poorer graft outcomes.
Source: BMC Nephrology
Institutions: Monash Medical Centre, Monash University, Australian Red Cross Lifeblood, The University of Melbourne, Fiona Stanley Hospital, Queensland Health, The Alfred Hospital, Peter Doherty Institute, Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide University, The University of Adelaide, The University of Queensland, Princess Alexandra Hospital, The University of Sydney, Children's Hospital at Westmead, Westmead Hospital, Edith Cowan University, The University of Western Australia, Sir Charles Gairdner Hospital
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7164934663