title: Immunologic outcome in elderly kidney transplant recipients: is it time for HLA-DR matching?
abstract: The Eurotransplant Senior Program (ESP) neglects HLA matching for elderly (≥65 years) kidney transplant recipients (KTR). Few data regarding the influence of DR matching on clinical and immunologic outcome in elderly KTR exist.
  
  
  
  This retrospective long-term observational study included 244 elderly out of n = 972 adult KTR between 2004 and 2014. Data analysis included patient and graft survival, biopsy-proven rejections [T-cell-mediated rejections (TCMR) and antibody-mediated rejections] and development of de novo donor-specific HLA antibodies (DSA). Outcome data were assessed over a maximum period of 10 years.
  
  
  
  Due to the nature of the ESP, elderly KTR showed significantly more HLA mismatches, shorter time on dialysis and shorter cold ischaemia time. Elderly KTR had significantly worse graft and patient survival, and after 7 years, the rate of de novo DSA (33 versus 25%, P = 0.034) and TCMR (39 versus 27%, P < 0.001) was significantly higher compared with younger KTR. Multivariate analysis identified donor age, delayed graft function and HLA-DR mismatches as independent risk factors for TCMR. Within the group of elderly KTR, HLA-DR mismatches were associated with a significantly higher incidence of TCMR and development of de novo DSA. Occurrence of TCMR and de novo DSA in elderly KTR resulted in significantly worse graft survival.
  
  
  
  In elderly KTR, HLA-DR mismatches are independent risk factors for TCMR and the development of all classes of de novo DSA, both of which significantly impair graft survival. Introduction of HLA-DR matching in elderly KTR might significantly improve immunologic and overall outcome.
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Halleck
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Dmytro
authors.initials: D
authors.lastname: Khadzhynov
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Liefeldt
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Schrezenmeier
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Lehner
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Duerr
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Danilo
authors.initials: D
authors.lastname: Schmidt
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Jamal
authors.initials: J
authors.lastname: Bamoulid
authors.affiliation: Department of Transfusion Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lachmann
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Waiser
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.affiliation: Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Staeck
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000276:immunology / Q000378:metabolism / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D006684:HLA-DR Antigens
keywords: Eurotransplant Senior Program; HLA-DR matching; elderly kidney transplant recipients; graft survival; immunologic outcomes