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Living Donation and Pre-Emptive Transplantation Are More Important Than HLA Matching in Pediatric Kidney
Alicia Paessler1, Ioannis D Kostakis2, Ioannis Loukopoulos1,3,4
1Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Insights
Living donation and pre-emptive transplantation significantly improve pediatric kidney transplant outcomes, surpassing the impact of HLA matching. These factors enhance graft and patient survival, offering better long-term results.
Area of Science:
- Nephrology
- Immunology
- Transplantation Science
Background:
- Human Leukocyte Antigen (HLA) matching is crucial for kidney transplant success.
- The impact of living donation and pre-emptive transplantation on outcomes in pediatric kidney recipients with varying HLA matches requires further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric kidney transplants based on HLA matching.
- To determine if living donation or pre-emptive transplantation can mitigate the negative effects of HLA mismatches in pediatric kidney recipients.
Main Methods:
- Retrospective analysis of the OPTN Registry data for pediatric kidney transplants (1987-2020) in the USA.
- Analysis of 21,500 pediatric kidney transplants, stratified by HLA mismatches, donor type (living vs. deceased), and pre-transplant dialysis status.
Main Results:
- Unfavorable HLA matches were associated with increased delayed allograft function and reduced allograft survival.
- Pediatric patients receiving unfavorable HLA-matched transplants from living donors showed better 5-year allograft survival (79%) than those with favorable HLA matches from deceased donors (71%).
- Pre-emptive transplantation in pediatric patients with unfavorable HLA matches resulted in superior 5-year allograft (83%) and patient survival (98%) compared to non-pre-emptive transplants with favorable HLA matches (78% and 96%, respectively).
Conclusions:
- Living donation and pre-emptive transplantation are more impactful on clinical outcomes than HLA matching in pediatric kidney transplantation.
- These strategies significantly improve allograft and patient survival, offering a better prognosis for pediatric kidney transplant recipients.
Abstract:
Poorly HLA matched transplants have poorer long-term outcomes, however it is unclear whether living donation or pre-emptive transplantation can counteract the effects of HLA mismatches. We reviewed the long-term outcomes of paediatric kidney transplants with different HLA matches and aimed to identify other factors which may contribute significantly to long-term outcomes. We conducted a retrospective registry analysis of all pediatric kidney transplants from 1987-2020 in the USA from the OPTN Registry. These were analysed by HLA mismatches and compared by pre-transplant dialysis status and donor type. 21,500 patients were included for analysis. Overall, patients with unfavourable HLA matches had higher rates of delayed allograft function and lower allograft survival. However, patients with unfavourable HLA matched transplants from living donors had better allograft survival than patients with favourable HLA matched transplants from deceased donors (79% at 5 years vs. 71%, p < 0⋅01). Patients with pre-emptive unfavourable HLA matched transplants had better allograft and patient survival than patients with non-pre-emptive favourable HLA matched transplants (83% at 5 years vs. 78%, p = 0⋅02% and 98% vs. 96%, p < 0⋅01 respectively). In conclusion, living donation and pre-emptive transplantation have a more significant impact on clinical outcomes and lead to better allograft and patient survival than HLA matching.
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