A Comparison Between Recipients Receiving Matched Kidney and Those Receiving Mismatched Kidney from the Same Cadaver Donor

Abstract

The optimal allocation of cadaveric kidneys for transplantation with reference to human leukocyte antigen (HLA) match and sharing these organs to a distant center remains controversial. The current analysis was performed using the United Network for Organ Sharing (UNOS) database for cadaveric kidney transplants (Tx) between 1988 and 1997. The graft survivals of zero-mismatch (matched) kidneys with the mate (mismatched) kidneys were compared. There were 2385 donors and 4770 Tx. Significant differences in recipient demographics between matched and mismatched Tx were: fewer African-American race (AA) in the matched group (9.0% vs. 21.9%), higher number of previous Tx (25.5% vs. 14.8%) and elevated mean cold ischemia time (24.0 vs. 22.2 h). Post-Tx dialysis requirements were similar (22.8% vs. 24.1%, p Ω0.62) and matched kidneys had to travel more distance (920 vs. 232 miles). Using a Cox model, the matched group had a decreased relative hazard of graft failure of 23.0% (p Ω0.0002) or 35% (p ∞0.0001) with and without censoring for death. There was significantly better graft survival in the matched recipients in all pairs except AA (matched) and non-AA (mismatched). For older donors (Ն 50 years, n Ω 1508), the matched grafts survival was marginally significant (p Ω0.05). Matched kidneys have improved survival compared with the mismatched kidneys despite the longer distance traveled. The benefit of mismatched transplants was predominantly seen in non-AA.

HLA-A, -B, and -DR Zero-Mismatched Kidneys Shipped to the University of Wisconsin, Madison, 1993–2006: Superior Graft Survival Despite Longer Preservation Time

“…The results of this single-center study confirm the superiority of the 0MM shipped-in kidney transplant over a locally procured, more than 0MM organ as reported previously (7, 8, 10, 11). Although kidney transplant recipients at our center benefitted overall from the mandated sharing of HLA 0MM kidneys, a short-term follow-up (<3 years) might lead to the false conclusion that the main benefit lies in the HLA-sensitized patient population because clear differences were observed early on in that subgroup when kidneys of comparable age and donor quality were compared (Fig.…”

“…This difference in graft survival was largely due to a 10% lower incidence of transplant rejection, particularly in patients with low (0%–9%) or intermediate (10%–79%) panel reactive antibodies (PRA). These results showing a graft survival benefit of 0MM shipped kidneys were confirmed in a separate study of paired donor kidney transplants (11). It should be noted that the most highly sensitized patients, those with antibodies reactive to 80% or more of a random panel of blood donors, did not enjoy a significant graft survival benefit from the 0MM sharing program (10).…”

“…The distant donor organ must be shipped before transplantation, but in this study, as has been reported previously for multicenter analysis (11, 25), the increase in total preservation time over local organs is in the order of only 1 to 2 hr. There are a variety of tests that must be performed before the transplant, which also retard the speed with which the surgeon can transplant the locally procurred kidney; it should also be noted that surgical teams and OPOs are more confident in their organ preservation methods because of major advancements in preservation research during the past 23 years (26).…”

HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: Implications for donor lung allocation

“…1 Retrospective data also suggest that a favorable HLA match offers a significant survival advantage, freedom from rejection and freedom from developing graft vascular disease in cardiac transplant recipients. 2,3 Since May 2005, lungs have been allocated utilizing the lung allocation score (LAS) to determine recipient priority.…”

Human leukocyte antigen and the allocation of kidneys from cadaver donors in the United Kingdom

“…This may lead to graft dysfunction and poorer long-term results. However, there is evidence from registry data that HLA matching has a highly significant impact even with short cold ischemia times (10) and that shared, well-matched kidneys have significantly better survival compared with paired, nonmatched kidneys (11).…”