TY - JOUR
T1 - A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the Eurotransplant Senior Program
AU - de Fijter, Johan
AU - Dreyer, Geertje
AU - Mallat, Marko
AU - Budde, Klemens
AU - Pratschke, Johann
AU - Klempnauer, Jürgen
AU - Zeier, Martin
AU - Arns, Wolfgang
AU - Hugo, Christian
AU - Rump, Lars Christian
AU - Hauser, Ingeborg
AU - Schenker, Peter
AU - Schiffer, Mario
AU - Grimm, Marc Oliver
AU - Kliem, Volker
AU - Olbricht, Christoph J.
AU - Pisarski, Przemyslaw
AU - Banas, Bernhard
AU - Suwelack, Barbara
AU - Hakenberg, Oliver
AU - Berlakovich, Gabriela
AU - Schneeberger, S.
AU - van de Wetering, Jacqueline
AU - Berger, Stefan
AU - Bemelman, Frederike
AU - Kuypers, Dirk
AU - Heidt, Sebastiaan
AU - Rahmel, Axel
AU - Claas, Frans
AU - Peeters, Patrick
AU - Oberbauer, R.
AU - Heemann, Uwe
AU - Krämer, Bernhard
AU - Tieken, I.
AU - Haasnoot, G.
AU - van Meel, M.
AU - Rump, L. C.
AU - Rosenkranz, A.
AU - Horn, S.
AU - Margreiter, R.
AU - Schneeberger, S.
AU - Oberbauer, R.
AU - Pohanka, E.
AU - Függer, F.
AU - Mühlbacher, F.
AU - Berlakovich, G.
AU - Meurisse, M.
AU - Bartels, M.
AU - Seelen, M. A.J.
AU - van Zuilen, A. D.
N1 - Publisher Copyright:
© 2023 International Society of Nephrology
PY - 2023/9
Y1 - 2023/9
N2 - The Eurotransplant Senior Program (ESP) has expedited the chance for elderly patients with kidney failure to receive a timely transplant. This current study evaluated survival parameters of kidneys donated after brain death with or without matching for HLA-DR antigens. This cohort study evaluated the period within ESP with paired allocation of 675 kidneys from donors 65 years and older to transplant candidates 65 years and older, the first kidney to 341 patients within the Eurotransplant Senior DR-compatible Program and 334 contralateral kidneys without (ESP) HLA-DR antigen matching. We used Kaplan-Meier estimates and competing risk analysis to assess all cause mortality and kidney graft failure, respectively. The log-rank test and Cox proportional hazards regression were used for comparisons. Within ESP, matching for HLA-DR antigens was associated with a significantly lower five-year risk of mortality (hazard ratio 0.71; 95% confidence interval 0.53-0.95) and significantly lower cause-specific hazards for kidney graft failure and return to dialysis at one year (0.55; 0.35-0.87) and five years (0.73; 0.53-0.99) post-transplant. Allocation based on HLA-DR matching resulted in longer cold ischemia (mean difference 1.00 hours; 95% confidence interval: 0.32-1.68) and kidney offers with a significantly shorter median dialysis vintage of 2.4 versus 4.1 yrs. in ESP without matching. Thus, our allocation based on HLA-DR matching improved five-year patient and kidney allograft survival. Hence, our paired allocation study suggests a superior outcome of HLA-DR matching in the context of old-for-old kidney transplantation.
AB - The Eurotransplant Senior Program (ESP) has expedited the chance for elderly patients with kidney failure to receive a timely transplant. This current study evaluated survival parameters of kidneys donated after brain death with or without matching for HLA-DR antigens. This cohort study evaluated the period within ESP with paired allocation of 675 kidneys from donors 65 years and older to transplant candidates 65 years and older, the first kidney to 341 patients within the Eurotransplant Senior DR-compatible Program and 334 contralateral kidneys without (ESP) HLA-DR antigen matching. We used Kaplan-Meier estimates and competing risk analysis to assess all cause mortality and kidney graft failure, respectively. The log-rank test and Cox proportional hazards regression were used for comparisons. Within ESP, matching for HLA-DR antigens was associated with a significantly lower five-year risk of mortality (hazard ratio 0.71; 95% confidence interval 0.53-0.95) and significantly lower cause-specific hazards for kidney graft failure and return to dialysis at one year (0.55; 0.35-0.87) and five years (0.73; 0.53-0.99) post-transplant. Allocation based on HLA-DR matching resulted in longer cold ischemia (mean difference 1.00 hours; 95% confidence interval: 0.32-1.68) and kidney offers with a significantly shorter median dialysis vintage of 2.4 versus 4.1 yrs. in ESP without matching. Thus, our allocation based on HLA-DR matching improved five-year patient and kidney allograft survival. Hence, our paired allocation study suggests a superior outcome of HLA-DR matching in the context of old-for-old kidney transplantation.
KW - allocation
KW - Eurotransplant Senior Program
KW - histocompatibility
KW - HLA-DR matching
KW - kidney transplantation
KW - old-for-old allocation
UR - http://www.scopus.com/inward/record.url?scp=85166017423&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2023.05.025
DO - 10.1016/j.kint.2023.05.025
M3 - Article
C2 - 37343659
AN - SCOPUS:85166017423
SN - 0085-2538
VL - 104
SP - 552
EP - 561
JO - Kidney International
JF - Kidney International
IS - 3
ER -