Impact of HLA polymorphisms among cadaveric donors on kidney graft allocation

Area of Science:

• Immunogenetics
• Transplantation immunology

Background:

• End-stage renal disease (ESRD) necessitates kidney transplantation.
• Human Leukocyte Antigen (HLA) matching is crucial for successful transplantation.
• Understanding HLA frequencies in patient and donor populations optimizes donor pool strategies.

Purpose of the Study:

• To determine HLA-A, -B, and -DRB1 allele frequencies in Croatian ESRD patients.
• To compare HLA distribution and mismatches between Croatian and Eurotransplant (ET) donors.
• To assess the impact of donor pool diversity on kidney transplant outcomes.

Main Methods:

• Analysis of HLA-A, -B, and -DRB1 frequencies in 861 Croatian ESRD patients.
• Comparison of HLA mismatches (MMs) in patients receiving grafts from Croatian (n=422) vs. ET (n=285) cadaveric donors.
• Statistical analysis of HLA gene associations with donor origin and patient sensitization.

Main Results:

• Specific HLA-B and HLA-DRB1 alleles showed differential distribution between Croatian and ET donors.
• ABDR MM 000 was more common with ET donors; MM 222 was more frequent with Croatian donors.
• Sensitized patients were more likely to receive kidneys from ET donors (P < .0001).

Conclusions:

• Diverse HLA gene distributions across organ donor pools enhance the probability of finding highly matched kidney grafts.
• Kidney exchange programs benefit from varied HLA profiles to improve transplantation success rates.
• Strategic donor pool management is key to overcoming HLA matching challenges in ESRD patients.