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Temporal Changes in the Impact of HLA Mismatching Among Pediatric Kidney Transplant Recipients
- Source :
- Transplantation
- Publication Year :
- 2019
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2019.
-
Abstract
- BACKGROUND Allocation for pediatric deceased-donor kidney transplantation (pDDKT) in the United States now de-emphasizes HLA matching to improve equality in access to transplantation, but other national systems still consider HLA matching due to concerns about graft survival. We hypothesized that the impact of HLA mismatching has decreased over time due to advances including improved immunosuppression. METHODS Using Scientific Registry of Transplant Recipient data, we analyzed whether the association between the number of HLA mismatches and outcomes of first-time pDDKTs changed between 2 eras: 1995 to 2004 (N = 2854) and 2005 to 2014 (N = 4643). RESULTS Between eras, the median number of mismatches increased from 4 to 5 (P < 0.001). Overall graft failure risk was higher among HLA-mismatched versus HLA-matched transplants (adjusted hazard ratio 1.211.431.69 for 3-6 versus 0-2 mismatches; P < 0.001), and this association was similar pre-2005 and post-2005 (Pinteraction = 0.5). Median panel-reactive antibody change at relisting increased from 79 to 85 (P = 0.01), but the association between number of HLA mismatches and panel-reactive antibody change was similar between eras (Pinteraction = 0.6). CONCLUSIONS Our finding that increased HLA mismatching continues to impact graft survival, with 43% higher risk of graft failure, highlights the tradeoff between transplant access equity and outcomes and calls into question the deemphasis on HLA matching in pDDKT allocation in the United States.
- Subjects :
- Adult
Male
Oncology
medicine.medical_specialty
Time Factors
Graft failure
Adolescent
Transplant recipient
medicine.medical_treatment
Human leukocyte antigen
030230 surgery
Risk Assessment
Kidney transplant
Article
Donor Selection
Young Adult
03 medical and health sciences
0302 clinical medicine
HLA Antigens
Risk Factors
Internal medicine
Humans
Medicine
Registries
Child
Kidney transplantation
Transplantation
business.industry
Graft Survival
Hazard ratio
Age Factors
Immunosuppression
medicine.disease
Kidney Transplantation
Treatment Outcome
Histocompatibility
Female
030211 gastroenterology & hepatology
business
Immunosuppressive Agents
Subjects
Details
- ISSN :
- 00411337
- Volume :
- 103
- Database :
- OpenAIRE
- Journal :
- Transplantation
- Accession number :
- edsair.doi.dedup.....0793612290b1dfdbc3a2a7f8acef702f