Temporal changes in the impact of HLA mismatching among pediatric kidney transplant recipients

Jessica M. Ruck; Annette M. Jackson; Allan B. Massie; Dorry L. Segev; Niraj Desai; Jacqueline Garonzik-Wang

doi:10.1097/TP.0000000000002426

Temporal changes in the impact of HLA mismatching among pediatric kidney transplant recipients

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

School of Medicine

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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 _1.211.43_1.69 for 3-6 versus 0-2 mismatches; P < 0.001), and this association was similar pre-2005 and post-2005 (P_interaction = 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 (P_interaction = 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 language	English (US)
Pages (from-to)	1267-1271
Number of pages	5
Journal	Transplantation
Volume	103
Issue number	6
DOIs	https://doi.org/10.1097/TP.0000000000002426
State	Published - Jun 1 2019

ASJC Scopus subject areas

Transplantation

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10.1097/TP.0000000000002426

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@article{f552ee7894cf4967b0ca7335cc85a40f,

title = "Temporal changes in the impact of HLA mismatching among pediatric kidney transplant recipients",

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.",

author = "Ruck, {Jessica M.} and Jackson, {Annette M.} and Massie, {Allan B.} and Segev, {Dorry L.} and Niraj Desai and Jacqueline Garonzik-Wang",

note = "Funding Information: This work was supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The first author was supported by a Doris Duke Clinical Research Foundation grant. Funding Information: 3Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 4Scientific Registry of Transplant Recipients, Minneapolis, MN. This work was supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The first author was supported by a Doris Duke Clinical Research Foundation grant. Publisher Copyright: {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2019",

month = jun,

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doi = "10.1097/TP.0000000000002426",

language = "English (US)",

volume = "103",

pages = "1267--1271",

journal = "Transplantation",

issn = "0041-1337",

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number = "6",

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T1 - Temporal changes in the impact of HLA mismatching among pediatric kidney transplant recipients

AU - Ruck, Jessica M.

AU - Jackson, Annette M.

AU - Massie, Allan B.

AU - Segev, Dorry L.

AU - Desai, Niraj

AU - Garonzik-Wang, Jacqueline

N1 - Funding Information: This work was supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The first author was supported by a Doris Duke Clinical Research Foundation grant. Funding Information: 3Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 4Scientific Registry of Transplant Recipients, Minneapolis, MN. This work was supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The first author was supported by a Doris Duke Clinical Research Foundation grant. Publisher Copyright: © 2019 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

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Temporal changes in the impact of HLA mismatching among pediatric kidney transplant recipients

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