HLA-matched kidney transplantation in the era of modern immunosuppressive therapy

BACKGROUND The effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys. METHOD We performed a retrospective analysis of HLA matched (M) and mismatched (MM) kidney transplants in our center. Tacrolimus, mycophenolic acid, and steroids were used as maintenance therapy and basiliximab induction was added for high-risk patients. RESULT A total of 229 kidney transplants were included with median follow-up of 5.1 years. The 5-year death-censored graft survival by Kaplan-Meier method was significantly higher in the M group than in the MM group for deceased-donor kidney transplants (log-rank, p = .018). This graft survival advantage was detected in patients with a peak panel reactive antibody (PRA) greater than 20% (p = .023), but not in those with a PRA level of less than 20% (p = .32). The graft survival was not statistically different for live donor kidney transplants (p = .077). A mismatched kidney was an independent risk for graft loss (hazard ratio: 2.27, 95% confidence interval: 1.009–5.09, p = .047) and acute rejection was a significant cause of graft loss in mismatched deceased-donor transplants (p = .035). CONCLUSION Acute rejection remains a significant cause of graft loss in HLA-6-antigen mismatched deceased-donor kidney transplants. Our data support mandatory sharing of HLA-matched kidneys in sensitized patients with a PRA level greater than 20%.