Rethinking the advantage of zero-HLA mismatches in unrelated living donor kidney transplantation: implications on kidney paired donation

Abstract

SummaryThe OPTN/UNOS Kidney Paired Donation (KPD) Pilot Program allocates priority to zero-HLA mismatches. However, in unrelated living donor kidney transplants (LDKT)-the same donor source in KPD-no study has shown whether zero-HLA mismatches provide any advantage over >0 HLA mismatches. We hypothesize that zero-HLA mismatches among unrelated LDKT do not benefit graft survival. This retrospective SRTR database study analyzed LDKT recipients from 1987 to 2012. Among unrelated LDKT, subjects with zero-HLA mismatches were compared to a 1:1-5 matched (by donor age AE1 year and year of transplantation) control cohort with >0 HLA mismatches. The primary endpoint was death-censored graft survival. Among 32,654 unrelated LDKT recipients, 83 had zero-HLA mismatches and were matched to 407 controls with >0 HLA mismatches. Kaplan-Meier analyses for death-censored graft and patient survival showed no difference between study and control cohorts. In multivariate marginal Cox models, zero-HLA mismatches saw no benefit with death-censored graft survival (HR = 1.46, 95% CI 0.78-2.73) or patient survival (HR = 1.43, 95% CI 0.68-3.01). Our data suggest that in unrelated LDKT, zero-HLA mismatches may not offer any survival advantage. Therefore, particular study of zero-HLA mismatching is needed to validate its place in the OPTN/UNOS KPD Pilot Program allocation algorithm.

The Risk of Transplant Failure With HLA Mismatch in First Adult Kidney Allografts 2: Living Donors, Summary, Guide

“…A recent retrospective analysis matched 83 0-HLA mismatches to 407 controls with more than 0 HLA mismatches in living donors; the authors reported that 0-HLA mismatch did not confer improved death-censored graft survival and patient survival. 7 In another study, while HLA-DR mismatch was a risk factor for acute rejection, HLA mismatch did not increase the risk of allograft loss or patient death. 5 Moreover, the adjusted 5-year allograft survival rate for unrelated living kidney transplantation was similar to the haploidentical living donation.…”

When a zero mismatch is no longer superior

“…Among all zero‐HLA mismatched living donor transplants, a significant benefit in death‐censored graft survival was seen in related (83%) over unrelated (78%) living donor transplant recipients. Finally, zero‐HLA mismatching was not associated with improved patient survival after living‐unrelated kidney transplantation .…”

“…In this edition of Transplant International , Casey et al . report the results of their study on the effect of the degree of HLA matching on graft survival after living‐unrelated donor kidney transplantation. Using data from the OPTN Scientific Registry of Transplant Recipients, 109 987 recipients of a living donor kidney transplanted in the USA between 1 October 1987 and 4 September 2012 were identified.…”

“…The study group consisted of the 83 patients who received a zero‐HLA mismatched kidney from a living‐unrelated donor. These patients were matched retrospectively (for donor age and transplantation year) in a 1:1‐5 ratio to 407 patients who received a >0 HLA mismatched kidney from a living‐unrelated donor .…”

Abdominalchirurgie trifft Nephrologie: Wichtige nephrologische Aspekte vor und nach Nieren- bzw. Lebertransplantation

“…Schließlich stellt die verlängerte kalte Ischämiezeit (wie in der konventionellen Leichenspende häufig der Fall) einen relevanten Risikofaktor für das postoperative Auftreten einer verzögerten Funktionsaufnahme des Transplantats (Delayed Graft Function, DGF) wie auch für das Auftreten von akuten Abstoßungsepisoden dar [4,5]. Eine kürzlich durchgeführte Analyse hinsichtlich des Nutzens einer HLA-Kompatibilität zwischen Lebendspender und Organempfänger hat keinen Vorteil zum herkömmlichen Verfahren aufgezeigt [6].…”