A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the Eurotransplant Senior Program
Johan W. de Fijter, Geertje J. Dreyer, Marko J.K. Mallat, Klemens Budde, Johann Pratschke, Jürgen Klempnauer, Martin Zeier, Wolfgang Arns, Christian Hugo, Lars‐Christian Rump, I. Häuser, Peter Schenker, Mario Schiffer, Marc‐Oliver Grimm, Volker Kliem, Christoph J. Olbricht, Przemyslaw Pisarski, Bernhard Banas, Barbara Suwelack, Oliver W. Hakenberg, Gabriela Berlakovich, Stefan Schneeberger, Jacqueline van de Wetering, Stefan P. Berger, Fréderike J. Bemelman, Dirk Kuypers, Sebastiaan Heidt, Axel Rahmel, Frans H.J. Claas, Patrick Peeters, Rainer Oberbauer, Uwe Heemann, Bernhard K. Krämer, Ineke Tieken, Geert W. Haasnoot, Marieke van Meel, L. C. Rump, Alexander R. Rosenkranz, Sarah Horn, R. Margreiter, Stefan Schneeberger, Rainer Oberbauer, Erich Pohanka, Fabio Fugger, F Mühlbacher, Gabriela Berlakovich, Michel Meurisse, Laurent Weekers, Dirk Ysebaert, Karl Martin Wissing, Dimitri Mikhalski, Michel Mourad, Wim Van Biesen, Dirk Kuypers, J. Floege, Matthias Anthuber, Richard Viebahn, Peter Schenker, Klemens Budde, Johann Pratschke, Walter Zidek, S. Melchior, Rainer P. Woitas, CP Strassburg, Christian Hugo, Manfred P. Wirth, Mario Schiffer, Andreas Kribben, Przemyslaw Pisarski, S. Fichtner-Feigl, Marion Haubitz, Rolf Weimer, P. Weithofer, P. Fornara, Laura Fisher, Urban Sester, Martin Zeier, Volker Kliem, l Klempnauer, Marc‐Oliver Grimm, Ulrich Kunzendorf, D. Stippel, Wolfgang Arns, Christian Mönch, Martin Nitschke, Meike Bartels, Bernhard K. Krämer, B. Kruger, Uwe Heemann, Jacob Werner, Joachim Hoyer, Heiner Wolters, Barbara Suwelack, Jens Lutz, Bernhard Banas, Oliver W. Hakenberg, C.J. Olbricht, Marcin Kalus, V. Schwenger, Silvio Nadalin
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.