Completely HLA Mismatched Living Donor Kidneys Have Comparable Results to the Best Matched Deceased Donor Kidneys

Abstract

Background: HLA mismatches as a categorical variable is known to influence graft survival in deceased donor kidney transplantation. We studied the effect of HLA-A, -B, and -DR mismatches in a population with deceased and living donor kidney transplantations. Methods: All 1821 transplantations performed in our center from 1990 until 2010 were included in the analysis. Univariate and multivariate Cox proportional hazard analyses were performed. Three analyses were performed: HLA mismatches were included as a continuous variable, as a categorical variable (total number of mismatches), and as a binary variable (zero versus non-zero mismatches). Other variables included were year of transplantation, number of previous transplantations, pre-treatment, maximum PRA, current PRA, recipient gender and age, and donor type, gender and age. Results: 941 patients received a deceased donor kidney and 880 a living donor kidney. There were 494 failures, 337 in recipients of deceased donor kidneys and 157 in recipients of living donor kidneys. In multivariate Cox analysis, donor type and age, current PRA, and recipient age were found to have a significant influence on graft failure, censored for death. Number of HLA mismatches had a significant influence in all analyses. There was no interaction between donor type and HLA mismatches. Conclusion: Number of HLA mismatches has a significant influence on death-censored graft survival. This holds true for both deceased and living donor kidney transplantation. However, the risk of death-censored graft failure of a 2-2-2 mismatched living donor kidney is comparable to that of a 0-0-0 mismatched deceased donor kidney (figure 1).[Figure 1]