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

Michael Jin Casey, Xuerong Wen, Shehzad Rehman, Alfonso H. Santos, Kenneth A. Andreoni

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)401-409
Number of pages9
JournalTransplant International
Volume28
Issue number4
DOIs
StatePublished - Apr 1 2015

Keywords

  • human leukocyte antigen
  • kidney
  • living donor
  • mismatch
  • paired donation
  • transplant

ASJC Scopus subject areas

  • Transplantation

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