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Transplantation. 2014 Feb 15;97(3):330-6. doi: 10.1097/01.TP.0000435703.61642.43.

Transplantation results of completely HLA-mismatched living and completely HLA-matched deceased-donor kidneys are comparable.

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1 Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. 2 Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands. 3 Department of General Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 4 Address correspondence to: Mirjam Laging, M.Sc., Department of Internal Medicine, Erasmus Medical Center, Room D408, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.



Human leukocyte antigen (HLA) mismatches are known to influence graft survival in deceased-donor kidney transplantation. We studied the effect of HLA mismatches in a population of recipients of deceased-donor or living-donor kidney transplantations.


All 1998 transplantations performed in our center between 1990 and 2011 were included in this retrospective cohort study. Four different multivariable Cox proportional hazard analyses were performed with HLA mismatches as continuous variable, as categorical variable (total number of HLA mismatches), as binary variable (zero vs. nonzero HLA mismatches), and HLA-A, -B, and -DR mismatches included separately.


Nine hundred ninety-one patients received a deceased-donor kidney and 1007 received a living-donor kidney. In multivariable Cox analysis, HLA mismatches, recipient age, current panel-reactive antibodies, transplant year, donor age, calcineurin inhibitor treatment, and donor type were found to have a significant and independent influence on the risk of graft failure, censored for death. Variables representing the total number of HLA-A, -B, and -DR mismatches had a significant and comparable influence in all analyses.


The influence of HLA mismatches on death-censored graft survival holds true for both deceased- and living-donor kidney transplantation. However, the relative risk of death-censored graft failure of a 2-2-2 mismatched living-donor kidney is comparable with that of a 0-0-0 mismatched deceased-donor kidney.

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