title: Living Donation Has a Greater Impact on Renal Allograft Survival Than HLA Matching in Pediatric Renal Transplant Recipients.
abstract: BACKGROUND
  Living donor (LD) kidney transplantation accounts for around half of all pediatric renal transplant recipients and results in improved renal allograft survival. The aim of this study was to determine the effect of HLA matching on deceased and LD renal allograft outcomes in pediatric recipients.
  
  
  METHODS
  Data were obtained from the UK Transplant Registry held by NHS Blood and Transplant on all children who received a donation after brain death (DBD) or LD kidney-only transplant between 2000 and 2011. HLA-A, HLA-B and HLA-DR mismatches were categorized into 4 levels and 2 groups. Data were fully anonymized.
  
  
  RESULTS
  One thousand three hundred seventy-eight pediatric renal transplant recipients were analyzed; 804 (58%) received a DBD donor kidney, 574 (42%) received an LD kidney. Five-year renal allograft survival was superior for children receiving a poorly HLA-matched LD kidney transplant (88%, 95% confidence interval [95% CI], 84-91%) compared with children receiving a well HLA-matched DBD kidney transplant (83%, 95% CI, 80-86%, log rank test P = 0.03). Five-year renal allograft survival was superior for children receiving an LD kidney with 1 or 2 HLA-DR mismatches (88%, 95% CI, 84-91%) compared with children receiving a DBD kidney with 0 HLA-DR mismatches (83%, 95% CI, 80-86%, log rank test P = 0.03).
  
  
  CONCLUSIONS
  In children, poorly HLA-matched LD renal transplant outcomes are not inferior when compared with well HLA-matched DBD renal transplants. It is difficult to justify preferentially waiting for an improved HLA-matched DBD kidney when a poorer HLA-matched LD kidney transplant is available.
authors.affiliation: 1 Institute of Child Health, University College London, London, United Kingdom. 2 NHS Blood and Transplant, Bristol, United Kingdom. 3 Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Oxford University Hospitals, University of Oxford, Oxford, United Kingdom. 4 Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Matko
authors.initials: M
authors.lastname: Marlais
authors.forename: Alex
authors.initials: A
authors.lastname: Hudson
authors.forename: Laura
authors.initials: L
authors.lastname: Pankhurst
authors.forename: Susan V
authors.initials: SV
authors.lastname: Fuggle
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks