The distribution of HLA genes and HLA sensitization among patients on cadaveric kidney transplantation waiting list

U radu su analizirani bolesnici na listi čekanja za kadaveričnu transplantaciju bubrega (N=874) te njihovi kadaverični davatelji. Svim ispitanicima određeni su geni lokusa HLA-A, -B i -DRB1 metodom lančane reakcije polimerazom i oligonukleotidima specifičnih sekvenci (engl. Polymerase Chain Reaction – Sequence Specific Oligonucleotids – PCR-SSO), a senzibiliziranim bolesnicima protutijela anti-HLA određena su metodom Luminex. Geni HLA-A nisu pokazali statistički značajne razlike između bolesnika i kontrole. Gen HLA-B*08 je bio statistički značajno učestaliji među bolesnicima u odnosu na kontrolu, dok su manju učestalost pokazali HLA-DRB1*07 i HLA-DRB1*16. Usporedbom raspodjele gena HLA između kadaveričnih davatelja iz Hrvatske i Eurotransplanta, uočena je statistički značajno veća zastupljenost HLA-B*35, HLA-DRB1*11 i HLA-DRB1*16 među domaćim kadaveričnim davateljima te manja zastupljenost HLA-A*29, HLA-B*07, HLA-B*08, HLA-B*44 i HLA-B*40(B60). Broj nepodudarnosti HLA-ABDR „222“ bio je češće prisutan između primatelja i domaćih kadaveričnih davatelja, dok su nepodudarnosti „000“ i „101“ bile češće prisutne između primatelja i stranih kadaveričnih davatelja. Raspodjela gena HLA među nesenzibiliziranim i senzibiliziranim bolesnicima ukazala je na gen HLA-A*24 kao zaštitni za senzibilizaciju, dok su HLA-B*51, DRB1*13 i HLA-DRB1*14 čimbenici rizika za senzibilizaciju. Kod senzibiliziranih bolesnika najčešće su utvrđena protutijela anti-HLA usmjerena protiv: A23, A24, A25, B27, B35, B44, Cw2, Cw5, Cw7, Cw17, DR1, DR4, DR9, DR15 i DQ9.In this study we analyzed patients on waiting list (N=874) for kidney transplantation and their cadaveric donors. HLA-A, -B and -DRB1 genes were typed by polymerase chain reaction and sequence specific oligonucleotides (PCR-SSO) method, while HLA antibodies were determined by Luminex method. Frequency of HLA-A genes did not show significant difference between patients and controls. Among patients, HLA-B*08 gene was significantly more frequent than among controls, while HLA-DRB1*07 and HLA-DRB1*16 genes had a lower incidence. Comparison of HLA gene distribution between cadaveric donors from Croatia and Eurotransplant showed significantly higher incidence of HLA-B*35, HLA-DRB1*11 and HLA-DRB1*16, and lower incidence of HLA-A*29, HLA-B*07, HLA-B*08, HLA-B*44 and HLA-B*40(60) among national cadaveric donors. HLA mismatch “222” was more often found between recipients and national cadaveric donors, while HLA mismatch “000” and “101” were more frequent between recipients and foreign cadaveric donors. Based on HLA gene distribution analysis among non-sensitized and sensitized patients, we can suggest that HLA-A*24 has reduced risk for HLA sensitization, while HLA-B*51, HLA-DRB1*13 and HLA-DRB1*14 have increased risk for HLA sensitization. Among sensitized patients, HLA specificities against which antibodies were most commonly found were: A24, A23, A25, B27, B44, B35, Cw5, Cw2, Cw7, Cw17, DR1, DR4, DR9, DR15 and DQ9