Impact of HLA compatibility in recipients of kidneys from expanded criteria donors: A Collaborative Transplant Study Report

Abstract

Due to a widespread organ shortage, the use of expanded criteria donors (ECDs) in kidney transplantation has increased persistently, reaching approximately 40% in recent years. Whether human leucocyte antigen (HLA) matching between donor and recipient should be part of allocation algorithms in transplantation of ECD kidneys, and especially of ECD kidneys from ≥70‐year‐old donors, is still in question. To this end, 135,529 kidney transplantations performed between 2000 and 2017 and reported to the Collaborative Transplant Study were analysed and the impact of HLA‐A+B+DR mismatches on death‐censored graft and patient survival as well as on rejection episodes was investigated. Results were stratified according to donor status (standard criteria donor (SCD) versus ECD) and age of ECD. HLA incompatibility increased the five‐year death‐censored graft failure risk similarly strong in recipients of ECD and SCD transplants (hazard ratio (HR) per HLA mismatch 1.078 and 1.075, respectively; p < .001 for both). Its impact on rejection treatments during the first post‐transplant year was also significant but slightly weaker for recipients of ECD transplants (risk ratio (RR) per HLA mismatch 1.10 for ECD transplants and 1.13 for SCD transplants; p < .001 for both). Mortality increased gradually from zero to six HLA mismatches in recipients of SCD transplants, whereas for ECD transplants a significant increase was notable only from zero to more than zero mismatches. A significant but slightly less pronounced impact of HLA incompatibility on graft failure was observed in transplants from ≥70‐ compared with <70‐year‐old ECDs (HR per mismatch 1.047 and 1.093; p = .009 and < 0.001, respectively). The influence of HLA mismatches on rejection treatments was the same for both ECD age groups (RR = 1.10, p < .001 and p = .004, respectively). Our data indicate that HLA matching should be part of allocation algorithms not only in transplantation of kidneys from SCDs but also from ECDs.

Impact of cardiopulmonary resuscitation on outcome of kidney transplantations from braindead donors aged ≥65 years

“…In consequence, 93% of all KT recipients in the CPR group and 88% in the no‐CPR group were aged ≥65 years. Median CIT was 12.0 h in the CPR‐group and 11.4 h in the no‐CPR group, distinctly less than what is reported for the regular Eurotransplant kidney allocation system (about 16 h) 15,33 . Hence, when considering organ offers from ≥65‐year‐old with a history of CPR, we would primarily select similarly aged donors and aim for a short CIT.…”

“…than what is reported for the regular Eurotransplant kidney allocation system (about 16 h). 15,33 Hence, when considering organ offers from ≥65-year-old with a history of CPR, we would primarily select similarly aged donors and aim for a short CIT.…”

Influence of Calcineurin Inhibitor Choice on Outcomes in Kidney Transplant Recipients Aged ≥60 Y: A Collaborative Transplant Study Report

“…We believe this is particularly important for the subgroup of KT recipients with 4 to 6 HLA mismatches, which has become a prominent group, especially in the Eurotransplant area, because the introduction of the Eurotransplant Senior Program. 10,24 Elderly KT recipients are well known to have an elevated risk of infection as well as infection-related mortality, which often limits clinical decision making. 7,8,[25][26][27][28] To gain more detailed information on this important clinical endpoint, we assessed the infection-related hospitalization risk and found no difference in the overall risk of hospitalization due to infection between the 2 CNI groups in ≥60-y-old recipients, a finding which is in line with previous studies on younger recipients.…”

“…5-8 On the other hand, especially in Europe, KTs of elderly recipients are often characterized by multiple human leukocyte antigen (HLA) mismatches, which might substantiate a more potent immunosuppression. 9,10 The optimal immunosuppressive regimen in this setting remains unknown, partly because elderly KT recipients have been underrepresented in clinical trials. 5,7,11…”

“…The age limit of 60 y was chosen because of the reduced incidence of rejection treatments and the increased mortality reported for ≥60-y-old KT recipients, which indicates that these elderly recipients are a distinct biological group. 10,15…”