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Arch Surg. 2011 Jul;146(7):824-9. doi: 10.1001/archsurg.2011.147.

HLA-DR matching in organ allocation: balance between waiting time and rejection in pediatric kidney transplantation.

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  • 1Department of Surgery, University of California at San Francisco, San Francisco, CA 94143-0780, USA.

Abstract

OBJECTIVES:

To determine the impact of HLA-DR mismatching on rejection, graft survival, and sensitization in a local allocation system that emphasizes donor quality rather than HLA antigen matching for pediatric patients and to determine the likelihood of finding an appropriate donor based on HLA-DR mismatch.

DESIGN:

Retrospective cohort study.

SETTING:

A single institution.

PATIENTS:

A total of 178 patients younger than 21 years who underwent kidney transplantation with daclizumab induction between 1997 and 2006.

MAIN OUTCOME MEASURES:

The association between HLA-DR mismatching and rejection or graft survival was determined using survival analysis. Sensitization was defined as a posttransplantation panel reactive antibody level greater than 0% in patients with a pretransplantation level of 0%.

RESULTS:

Median follow-up was 4.1 years (interquartile range, 2.1-6.1 years). One- and 5-year graft survival rates were 97% and 82%, respectively. HLA-DRB1 mismatches were a significant risk factor for rejection; patients with 1- or 2-HLA-DRB1 mismatches had 1.7 times greater odds of rejection than those with 0-HLA-DR mismatches (P = .006). HLA-DRB1 mismatching was not a significant risk factor for either graft failure or sensitization, but history of rejection was an independent predictor of graft failure (hazard ratio, 7.7; P = .01) and sensitization (odds ratio, 9.7; P = .001). Although avoiding HLA-DRB1 mismatching reduces rejection, the probability of finding ABO-matched local donors younger than 35 years without DR mismatches was extremely low.

CONCLUSION:

Although avoiding HLA-DRB1 mismatching is beneficial, the likelihood of finding an HLA-DRB1-matched donor should also be considered in donor selection.

Comment in

PMID:
21768429
[PubMed - indexed for MEDLINE]
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