Send to:

Choose Destination
See comment in PubMed Commons below
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.

Author information

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



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.


Retrospective cohort study.


A single institution.


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


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%.


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.


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

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk