Consideration of Donor Age and Human Leukocyte Antigen Matching in the Setting of Multiple Potential Living Kidney Donors

Abstract

Background Defining living donor (LD)-related risk factors affecting kidney transplant outcome will allow better donor selection and more educated informed consent when there is more than one potential donor. We studied risk factors in a large cohort at a single institution. Methods We reviewed 1632 recipients who underwent LD kidney transplantation at the University of Minnesota between January 1, 1990, and October 1, 2009. Using Cox regression, we studied the effect of donor and recipient risk factors on patient and graft survival. We specifically examined the effect of donor age and human leukocyte antigen (HLA) matching because these are variables that may help clinical decision making when multiple potential donors exist. Results Mean donor age was 40.6 years for all transplants; 180 (11%) donors were 55 years or older, and 24 (1.5%) donors were older than 65 years. Mean number of HLA mismatches (per transplant) was 2.9 (29.2% of recipients had one to two HLA mismatches, 39.8% had three to four HLA mismatches, and 25% had five to six HLA mismatches). Donor age more than 65 years, five to six HLA mismatches, delayed graft function, and acute rejection were independent predictors of decreased patient and graft survival. When controlling for recipient age, donor age more than 65 years remained a risk factor for worse outcome. Conclusions Our data suggest that advanced donor age (>65 years) and degree of HLA mismatch (≥5) are independent donor-related risk factors associated with worse outcome. When multiple potential LDs exist, it may be ideal to attempt to use a donor younger than 65 years and with less than five HLA mismatches.

Clinical Role of Human Leukocyte Antigen in Health and Disease

“…Although anti-DP antibodies are frequently detected in sensitized patients, their impact on transplant outcome is still not clear and needs to be further evaluated [117]. In the context of kidney transplantation from live donors, donor age and HLA matching have recently been shown to be independent donor-related risk factors associated with both decreased patient and graft survival [123].…”

Advantages of nonhuman primates as preclinical models for evaluating stem cell-based therapies for Parkinson's disease

“…Clinical data have confirmed that matching MHC alleles between donor and host greatly mitigates the risk of immune rejection of transplanted cells or organs (Dunn et al, 2011;Rizzari et al, 2011;Vu et al, 2011;Held et al, 1994). As such, MHC matching plays a crucial role in the acceptance or rejection of any transplanted tissues (Magistris et al, 1992;Buus et al, 1987).…”

Transplantation Results of Completely HLA-Mismatched Living and Completely HLA-Matched Deceased-Donor Kidneys Are Comparable

“…Recently, Rizzari et al described a population of 1632 patients with HLA mismatches defined as 0, 1Y2, 3Y4, and 5Y6. A significant effect of HLA mismatches on the risk of graft failure was found in the highest category mismatches (13).…”