Temporal Changes in the Impact of HLA Mismatching Among Pediatric Kidney Transplant Recipients

Jessica M. Ruck, Annette M. Jackson, Allan B Massie, Dorry Segev, Niraj M Desai, Jacqueline Garonzik

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Allocation for pediatric deceased-donor kidney transplantation (pDDKT) in the United States now de-emphasizes HLA matching to improve equality in access to transplantation, but other national systems still consider HLA matching due to concerns about graft survival. We hypothesized that the impact of HLA mismatching has decreased over time due to advances including improved immunosuppression. METHODS: Using Scientific Registry of Transplant Recipient data, we analyzed whether the association between the number of HLA mismatches and outcomes of first-time pDDKTs changed between 2 eras: 1995 to 2004 (N = 2854) and 2005 to 2014 (N = 4643). RESULTS: Between eras, the median number of mismatches increased from 4 to 5 (P < 0.001). Overall graft failure risk was higher among HLA-mismatched versus HLA-matched transplants (adjusted hazard ratio 1.211.431.69 for 3-6 versus 0-2 mismatches; P < 0.001), and this association was similar pre-2005 and post-2005 (Pinteraction = 0.5). Median panel-reactive antibody change at relisting increased from 79 to 85 (P = 0.01), but the association between number of HLA mismatches and panel-reactive antibody change was similar between eras (Pinteraction = 0.6). CONCLUSIONS: Our finding that increased HLA mismatching continues to impact graft survival, with 43% higher risk of graft failure, highlights the tradeoff between transplant access equity and outcomes and calls into question the deemphasis on HLA matching in pDDKT allocation in the United States.

Original languageEnglish (US)
Pages (from-to)1267-1271
Number of pages5
JournalTransplantation
Volume103
Issue number6
DOIs
StatePublished - Jun 1 2019

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Pediatrics
Transplants
Kidney
Graft Survival
Kidney Transplantation
Tissue Donors
Antibodies
Immunosuppression
Registries
Transplantation
Transplant Recipients

ASJC Scopus subject areas

  • Transplantation

Cite this

Temporal Changes in the Impact of HLA Mismatching Among Pediatric Kidney Transplant Recipients. / Ruck, Jessica M.; Jackson, Annette M.; Massie, Allan B; Segev, Dorry; Desai, Niraj M; Garonzik, Jacqueline.

In: Transplantation, Vol. 103, No. 6, 01.06.2019, p. 1267-1271.

Research output: Contribution to journalArticle

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