HLA-identical living related kidney transplantation: Outcomes of a national multicenter study

Objectives: The kidney prognosis of HLA-identical seems theoretically very interesting with the lowest risk of acute rejection after that of identical twins. Objectives were to determine the prevalence of acute rejection and various complications in a cohort of HLA-identical living-related kidney transplant. Methods: A retrospective, multicenter study was conducted in seven university centers in Morocco, which included all recipients of an HLA-identical living-related kidney transplant performed between 1990 and 2019. Results: Data on 68 HLA-identical living-related kidney transplants were collected. The donors were siblings in 89.7%, the parents in 7.3%, and identical twins in 3% of cases. 53.6% of all recipients were under 35 years old, and 59.4% of them were male. 39.7% of all donors were under 35 years old, and 47% of them were male. 48.5% of HLA-identical living-related kidney transplants were performed before the year 2000. 18 kidney transplant biopsies were performed on 16 kidney transplant recipients. Seven episodes of acute rejection occurred in six patients, 8.8% of the whole cohort (n = 68). Two cases of acute rejection among the seven were related to poor adherence, cessation of immunosuppressive therapy, and loss of medical follow-up by these patients. These two patients were 20 years old at the time of kidney transplantation. The global kidney transplant survival was 66.7% versus 91.9% (P = 0.04) in the two patient groups having developed acute rejection and not having developed acute rejection, respectively. Conclusions: Acute rejection is a real threat to HLA-identical kidney transplant recipients. Therefore, it seems very important to codify the immunosuppressive regimen and to adopt a minimal and effective treatment.