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Published on: October 11, 2014
Survival Benefit with Kidney Transplants from HLA-Incompatible Live Donors
Babak J Orandi1, Xun Luo1, Allan B Massie1
1From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
Kidney transplants from human leukocyte antigen (HLA)-incompatible live donors significantly improve patient survival compared to waiting lists. This multicenter study confirms a survival benefit across various cross-match levels.
Area of Science:
- Nephrology
- Transplantation immunology
- Clinical research
Background:
- A single center reported a survival advantage for HLA-incompatible live donor kidney transplants over waiting list options.
- The generalizability of this single-center finding was previously uncertain.
Purpose of the Study:
- To assess the survival benefit of kidney transplantation from HLA-incompatible live donors in a multicenter setting.
- To validate previous single-center findings on the generalizability of HLA-incompatible live donor kidney transplants.
Main Methods:
- A 22-center study involving 1025 recipients of HLA-incompatible live donor kidney transplants.
- Comparison with control groups: those on the waiting list or receiving deceased donor transplants, and those only on the waiting list.
- Analysis conducted with and without data from the highest-volume center.
Main Results:
- HLA-incompatible live donor kidney transplant recipients showed higher survival rates at 1, 3, 5, and 8 years compared to both control groups (P<0.001).
- Significant 8-year survival benefits were observed across all donor-specific antibody levels and cross-match types.
- Excluding the highest-volume center did not alter the study's findings.
Conclusions:
- This multicenter study validates that HLA-incompatible live donor kidney transplants offer a substantial survival benefit.
- The benefit is evident when compared to patients awaiting deceased donor transplants or remaining on the waiting list.
- Findings were consistent regardless of patient antibody levels or cross-match results.
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