A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the Eurotransplant Senior Program

Eurotransplant Senior DR-compatible Program (ESDP) Study Group, Johan de Fijter*, Geertje Dreyer, Marko Mallat, Klemens Budde, Johann Pratschke, Jürgen Klempnauer, Martin Zeier, Wolfgang Arns, Christian Hugo, Lars Christian Rump, Ingeborg Hauser, Peter Schenker, Mario Schiffer, Marc Oliver Grimm, Volker Kliem, Christoph J. Olbricht, Przemyslaw Pisarski, Bernhard Banas, Barbara SuwelackOliver Hakenberg, Gabriela Berlakovich, S. Schneeberger, Jacqueline van de Wetering, Stefan Berger, Frederike Bemelman, Dirk Kuypers, Sebastiaan Heidt, Axel Rahmel, Frans Claas, Patrick Peeters, R. Oberbauer, Uwe Heemann, Bernhard K. Krämer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

The Eurotransplant Senior Program (ESP) has expedited the chance for elderly patients with kidney failure to receive a timely transplant. This current study evaluated survival parameters of kidneys donated after brain death with or without matching for HLA-DR antigens. This cohort study evaluated the period within ESP with paired allocation of 675 kidneys from donors 65 years and older to transplant candidates 65 years and older, the first kidney to 341 patients within the Eurotransplant Senior DR-compatible Program and 334 contralateral kidneys without (ESP) HLA-DR antigen matching. We used Kaplan-Meier estimates and competing risk analysis to assess all cause mortality and kidney graft failure, respectively. The log-rank test and Cox proportional hazards regression were used for comparisons. Within ESP, matching for HLA-DR antigens was associated with a significantly lower five-year risk of mortality (hazard ratio 0.71; 95% confidence interval 0.53-0.95) and significantly lower cause-specific hazards for kidney graft failure and return to dialysis at one year (0.55; 0.35-0.87) and five years (0.73; 0.53-0.99) post-transplant. Allocation based on HLA-DR matching resulted in longer cold ischemia (mean difference 1.00 hours; 95% confidence interval: 0.32-1.68) and kidney offers with a significantly shorter median dialysis vintage of 2.4 versus 4.1 yrs. in ESP without matching. Thus, our allocation based on HLA-DR matching improved five-year patient and kidney allograft survival. Hence, our paired allocation study suggests a superior outcome of HLA-DR matching in the context of old-for-old kidney transplantation.

Original languageEnglish
Pages (from-to)552-561
Number of pages10
JournalKidney International
Volume104
Issue number3
DOIs
Publication statusPublished - Sept-2023

Keywords

  • allocation
  • Eurotransplant Senior Program
  • histocompatibility
  • HLA-DR matching
  • kidney transplantation
  • old-for-old allocation

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