Open AccessRethinking the advantage of zero‐ HLA mismatches in unrelated living donor kidney transplantation: implications on kidney paired donation
Author(s) -
Casey Michael Jin,
Wen Xuerong,
Rehman Shehzad,
Santos Alfonso H.,
Andreoni Kenneth A.
Publication year - 2015
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12495
Subject(s) - medicine , human leukocyte antigen , proportional hazards model , cohort , transplantation , survival analysis , kidney transplantation , retrospective cohort study , cohort study , survival rate , donation , surgery , oncology , immunology , antigen , economics , economic growth
Summary The 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 ±1 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.