HLA matching for simultaneous pancreas-kidney transplantation in the United States: a multivariable analysis of the UNOS data.
BACKGROUND
As the incidence of diabetic nephropathy increases, especially in minority populations, more simultaneous pancreas-kidney (SPK) transplants are being performed both in the United States and worldwide. The role of matching on SPK outcomes and organ allocation remains controversial. The purpose of this analysis was to determine the influence of HLA matching using currently employed criteria on 5-year SPK graft survival.


METHODS
We performed an analysis of all 3,316 SPK transplants performed in the United States reported to the United Network for Organ Sharing (UNOS) between December 31, 1988 and December 31, 1994. Kaplan-Meier unadjusted 1- and 5-year graft survival with log rank comparisons and Cox multivariable regression models that adjusted for 12 confounding variables were used to analyze the influence of HLA matching on outcomes.


RESULTS
Despite low-grade HLA or DR matching or high levels of common reactive groups (CREG) mismatching, 1- and 5-year allograft survival rates were 90% and 78% for kidney, and 85% and 75% for pancreas transplantation.


CONCLUSIONS
SPK transplantation is associated with excellent outcomes independent of the level of HLA matching. These data support the hypothesis that SPK transplants need not be allocated based on matching criteria, thus minimizing organ ischemia time and promoting a more racially equitable allocation for SPKs in the US today.
Mancini
M J
MJ
Department of Medicine, The University of Virginia Health System, Charlottesville 22908, USA. rbi9u@unix.mail.virginia.edu
Connors
A F
AF
Wang
X Q
XQ
Nock
S
S
Spencer
C
C
Mccullough
C
C
Lobo
P
P
Isaacs
R
R
D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data; D008297:Male; D008913:Minority Groups; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000276:immunology* / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
D006680:HLA Antigens