Does HLA-Incompatible Transplantation Confer a Survival Advantage in the UK?

M. Manook,¹ Z. Ahmed,¹ R. Johnson,² O. Shaw,¹ N. Kessaris,¹ A. Dorling,¹ N. Mamode.¹

¹Renal, Guy's & St Thomas'
Hospital, London, United Kingdom
²NHS Blood & Transplant, Bristol, United Kingdom.

Meeting: 2015 American Transplant Congress

Abstract number: D52

Keywords: Highly-sensitized, Kidney transplantation, Outcome, Waiting lists

Session Information

Session Name: Poster Session D: Disparities in Healthcare Outcomes

Session Type: Poster Session

Date: Tuesday, May 5, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Introduction: HLA-incompatible transplantation is perceived as being a 'high-risk' option with increased mortality and morbidity for transplantation of sensitized recipients of renal transplants. Data from the USA has indicated that HLA-incompatible transplantation confers an increased patient survival compared to 'dialysis only', or 'dialysis and transplant'. This study aims to determine whether this survival advantage applies in the UK, where options for deceased donor transplantation are different.

Methods: UK patients listed for transplantation at 1.1.2007, and all subsequent listings to 31.12.2013 were accessed from the NHSBT waiting list on 6.11.2014. LD HLA-incompatible (HLAi) transplants were identified, and compared with LD compatible transplants (LDc, excluding paired scheme recipients), DD compatible transplants (DDc)and untransplanted (U) patients. Main outcome measures: Post-listing survival, time from listing to transplant.

Results: During the study period, of total cohort of 25089 patients listed for transplantation, 219 recipients received an HLAi transplant; 4498 an LDc; 11313 a DDc and 9059 were untransplanted. Using cox regression modelling of post-listing survival, adjusting for age at registration, gender, blood group, CRF at registration and duration of ESRF, compared to LDc, DDc had a hazard ratio (HR) for death of 1.6 (95% CI 1.31-1.88, p = <0.05); HLAi a HR of 2.5 (95% CI 1.55-3.98, p = <0.05) and remaining untransplanted conferred a HR of death of 6.9 (CI 95% 5.75-8.39, p = <0.05). For the transplanted recipients, mean time from listing to transplant was 540d for LDc (SD 622), HLAi 1091d (SD 848) & DDc 1078d (SD 1331), p = <0.05.

Discussion: HLAi transplantation confers a quantifiable survival advantage in the UK, compared to remaining untransplanted. Time from listing to transplant is significantly longer for patients receiving an HLA-i living donor transplant, compared to a compatible living donor. There may be scope to improve survival for patients coming forward with an HLA-incompatible living donor, by expediting the time from listing to transplantation. Further work with a fully matched cohort is planned.

To cite this abstract in AMA style:

Manook M, Ahmed Z, Johnson R, Shaw O, Kessaris N, Dorling A, Mamode N. Does HLA-Incompatible Transplantation Confer a Survival Advantage in the UK? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/does-hla-incompatible-transplantation-confer-a-survival-advantage-in-the-uk/. Accessed November 21, 2024.

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