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Previous Volume 339:1657-1664 December 3, 1998 Number 23 Next

	Full Text PDF Editorial by Sanfilippo, F. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background During pregnancy and nursing, a baby's developing immune system is intimately exposed to the mother's antigens. To determine whether this exposure is of clinical benefit to patients who later receive an allograft as an adult, we analyzed the outcome of primary renal transplantations from sibling donors.

Methods We retrospectively studied graft survival and rejection episodes in 205 patients who had received renal transplants at nine centers between 1966 and 1996 from sibling donors bearing maternal or paternal HLA antigens not inherited by the recipient. The sibling donors were categorized by analysis of family HLA-typing data.

Results In the multicenter analysis, graft survival was higher 5 years and 10 years after transplantation in recipients of kidneys from siblings expressing maternal HLA antigens not inherited by the recipient than in recipients of kidneys from siblings expressing paternal HLA antigens not inherited by the recipient (86 percent vs. 67 percent at 5 years and 77 percent vs. 49 percent at 10 years, P=0.006 for both comparisons). Paradoxically, there was a higher incidence of early rejection in the former group, suggesting that fetal and neonatal exposure to maternal antigens results in immunologic priming. Pretransplantation transfusions of donor blood reduced the incidence of acute rejection while preserving the beneficial effect of tolerance to noninherited maternal antigens on graft survival. Since 1986, new immunosuppressive drugs have lessened the short-term, but not the long-term, survival advantage of grafts expressing maternal HLA antigens not inherited by the recipient.

Conclusions In the transplantation of a kidney from a sibling donor who is mismatched with the recipient for one HLA haplotype, graft survival is higher when the donor has maternal HLA antigens not inherited by the recipient than when the donor has paternal HLA antigens not inherited by the recipient.

Source Information

From the Department of Surgery, University of Wisconsin, Madison (W.J.B., A.P.G., D.M.H., J.D.P., H.W.S.); the Departments of Immunohematology (F.H.J.C.) and Nephrology (H.F.), Leiden University Medical Center, Leiden, the Netherlands; the Laboratory of Immunogenetics and Transplantation, Oregon Health Sciences University, Portland (D.N.); the Departments of Pathology and Medicine, Washington University, St. Louis (T.M., D.C.B.); Dijkzigt University Hospital, Rotterdam, the Netherlands (T.G.); and Dendreon Corporation, Mountainview, Calif. (M.A.B.).

Address reprint requests to Dr. Burlingham at the Department of Surgery, University of Wisconsin Medical School, H4/748 Clinical Science Center, 600 Highland Ave., Madison, WI 53792.

Full Text of this Article

Related Letters:

The Effect of Tolerance to Noninherited Maternal HLA Antigens on the Survival of Renal Transplants from Sibling Donors
Opelz G., Burlingham W. J., Heisey D. M., Bean M. A.
Extract | Full Text  
N Engl J Med 1999; 340:1369-1370, Apr 29, 1999. Correspondence

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