title: Impact of HLA mismatch at first kidney transplant on lifetime with graft function in young recipients.
abstract: As HLA matching has been progressively de-emphasized in the American deceased donor (DD) kidney allocation algorithm, concerns have been raised that poor matching at first transplant may lead to greater sensitization and more difficulty finding an acceptable donor for a second transplant should the first transplant fail. We compared proportion of total observed lifetime with graft function after first transplant, and waiting times for a second transplant between individuals with different levels of HLA mismatch (MM) at first transplant. We studied patients recorded in the United States Renal Data System (1988-2009) who received a first DD transplant at age ≤21 years (n = 8433), and the subgroup who were listed for a second DD transplant following first graft failure (n = 2498). Compared with recipients of 2-3 MM first grafts, 4-6 MM graft recipients spent 12% less of their time and 0-1 MM recipients 15% more time with a functioning graft after the first transplant (both p < 0.0001); 4-6 MM recipients were significantly less likely (hazard ratio [HR] 0.87 [95% confidence interval 0.76, 0.98]; p = 0.03), and 0-1 MM recipients more likely (HR 1.26 [0.99, 1.60]; p = 0.06) to receive a second transplant after listing. The benefits of better HLA matching at first transplant on lifetime with graft function are significant, but relatively small.
authors.affiliation: Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montreal, QC, Canada; Montreal Children's Hospital Research Institute, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
authors.forename: B J
authors.initials: BJ
authors.lastname: Foster
authors.forename: M
authors.initials: M
authors.lastname: Dahhou
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.forename: R W
authors.initials: RW
authors.lastname: Platt
authors.forename: J M
authors.initials: JM
authors.lastname: Smith
authors.forename: J A
authors.initials: JA
authors.lastname: Hanley
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000097:blood / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008017:Life Expectancy; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D006680:HLA Antigens
keywords: Adolescence; HLA matching; graft survival; kidney allocation; kidney graft function; pediatric kidney transplantation; waiting time