title: HLA-DR matching in organ allocation: balance between waiting time and rejection in pediatric kidney transplantation.
abstract: OBJECTIVE
  To determine the impact of HLA-DR mismatching on rejection, graft survival, and sensitization in a local allocation system that emphasizes donor quality rather than HLA antigen matching for pediatric patients and to determine the likelihood of finding an appropriate donor based on HLA-DR mismatch.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A single institution.
  
  
  METHODS
  A total of 178 patients younger than 21 years who underwent kidney transplantation with daclizumab induction between 1997 and 2006.
  
  
  METHODS
  The association between HLA-DR mismatching and rejection or graft survival was determined using survival analysis. Sensitization was defined as a posttransplantation panel reactive antibody level greater than 0% in patients with a pretransplantation level of 0%.
  
  
  RESULTS
  Median follow-up was 4.1 years (interquartile range, 2.1-6.1 years). One- and 5-year graft survival rates were 97% and 82%, respectively. HLA-DRB1 mismatches were a significant risk factor for rejection; patients with 1- or 2-HLA-DRB1 mismatches had 1.7 times greater odds of rejection than those with 0-HLA-DR mismatches (P = .006). HLA-DRB1 mismatching was not a significant risk factor for either graft failure or sensitization, but history of rejection was an independent predictor of graft failure (hazard ratio, 7.7; P = .01) and sensitization (odds ratio, 9.7; P = .001). Although avoiding HLA-DRB1 mismatching reduces rejection, the probability of finding ABO-matched local donors younger than 35 years without DR mismatches was extremely low.
  
  
  CONCLUSIONS
  Although avoiding HLA-DRB1 mismatching is beneficial, the likelihood of finding an HLA-DRB1-matched donor should also be considered in donor selection.
authors.affiliation: Department of Surgery, University of California at San Francisco, San Francisco, CA 94143-0780, USA.
authors.forename: Lan T
authors.initials: LT
authors.lastname: Vu
authors.forename: Lee Ann
authors.initials: LA
authors.lastname: Baxter-Lowe
authors.forename: John
authors.initials: J
authors.lastname: Garcia
authors.forename: Marilyn
authors.initials: M
authors.lastname: McEnhill
authors.forename: Philip
authors.initials: P
authors.lastname: Summers
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Hirose
authors.forename: Marsha
authors.initials: M
authors.lastname: Lee
authors.forename: Peter G
authors.initials: PG
authors.lastname: Stock
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D000077561:Daclizumab; D046148:Donor Selection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods* / Q000401:mortality; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends; D014184:Transplantation, Homologous; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D006684:HLA-DR Antigens; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000077561:Daclizumab