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. 2018 Dec 19;5(1):e414.
doi: 10.1097/TXD.0000000000000856. eCollection 2019 Jan.

Nonimmunologic Donor-Recipient Pairing, HLA Matching, and Graft Loss in Deceased Donor Kidney Transplantation

Amanda Jean Vinson  1 , Bryce A Kiberd  1 , Roger B Davis  2 , Karthik K Tennankore  1
Affiliations

Nonimmunologic Donor-Recipient Pairing, HLA Matching, and Graft Loss in Deceased Donor Kidney Transplantation

Amanda Jean Vinson et al. Transplant Direct. .

Abstract

Background: In kidney transplantation, nonimmunologic donor-recipient (D-R) pairing is generally not given the same consideration as immunologic matching. The aim of this study was to determine how nonimmunologic D-R pairing relates to independent donor and recipient factors, and to immunologic HLA match for predicting graft loss.

Methods: Seven D-R pairings (race, sex, age, weight, height, cytomegalovirus serostatus, and HLA match) were assessed for their association with the composite outcome of death or kidney graft loss using a Cox regression-based forward stepwise selection model. The best model for predicting graft loss (including nonimmunologic D-R pairings, independent D-R factors, and/or HLA match status) was determined using the Akaike Information Criterion.

Results: Twenty three thousand two hundred sixty two (29.9%) people in the derivation data set and 9892 (29.7%) in the validation data set developed the composite outcome of death or graft loss. A model that included both independent and D-R pairing variables best predicted graft loss. The c-indices for the derivation and validation models were 0.626 and 0.629, respectively. Size mismatch (MM) between donor and recipient (>30 kg [D < R} and >15 cm [D < R]) was associated with poor patient and graft survival even with 0 HLA MM, and conversely, an optimal D-R size pairing mitigated the risk of graft loss seen with 6 HLA MM.

Conclusions: D-R pairing is valuable in predicting patient and graft outcomes after kidney transplant. D-R size matching could offset the benefit and harm seen with 0 and 6 HLA MM, respectively. This is a novel finding.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan Meier Curve for nonimmunologic size match versus immunologic HLA match between donors and recipients. (i) Optimal size match (>30 kg difference [D > R] and >15 cm [D > R]); suboptimal size match (>30 kg difference [D < R] and >15 cm [D < R]. Log-rank P value <0.001.
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