Graft and Patient Outcomes of Zero Human Leukocyte Antigen Mismatched Deceased and Live-Donor Kidney Transplant Recipients

Greater compatibility of human leukocyte antigen (HLA) alleles between kidney donors and recipients may lead to improved graft outcomes. This study aimed to compare the incidence of acute rejection and graft failure in zero HLA-mismatched recipients of living-related (LD) and deceased donor (DD) kidney transplants. Using data from the Australia and New Zealand Dialysis and Transplant Registry, we compared the risk of any and biopsy-proven acute rejection (BPAR) and graft failure in recipients of zero HLA-mismatched kidneys between LD and DD using logistic and Cox regression models. Of the 931 zero HLA-mismatched recipients transplanted between 1990-2012, 19 (2.0%) received kidneys from monozygotic/dizygotic twins (twin), 500 (53.7%) from non-twin LD and 412 (44.3%) from DD. Twin kidney transplant recipients did not experience rejection. Compared to DD transplant recipients, the risk of any acute rejection (adjusted odds ratio 0.52, 95%CI 0.34-0.79, p=0.002) and overall graft failure (adjusted hazard ratio 0.55, 95%CI 0.41-0.73, p<0.001) was significantly lower in LD recipients independent of initial immunosuppression, but not for BPAR (adjusted odds ratio 0.52, 95%CI 0.16-1.64, p=0.263). Zero HLA-mismatched DD kidney transplant recipients have a significantly higher risk of any acute rejection episodes and graft loss compared to zero HLA mismatched LD kidney transplant recipients. A cautious and careful approach in reducing immunosuppression appears to be warranted in this group of transplant recipients (read more)

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