Introduction:

ID-LDRT and 6M-CRT HLA recipients are thought to enjoy superior outcomes compared with those with 1 HLA lesser matching (5 HLA matched controls; 5M). We studied the outcome of each group, and indirectly explored the relative importance of minor-HLA and non-HLA matching.

Methodology:

ID-LDRT (n=62) and 6M-CRT (n=94) recipients at our center between 1988-2012 were identified. Controls were those with 5 HLA match within each group (n=42, and n=131, respectively), and matched for gender, age, and cold ischemia time (CIT). We compared actuarial renal allograft and patient survival using Kaplan-Meier log-rank test between ID-LDRT and 5M-LDRT as well as 6M-CRT and 5M-CRT. Significance was set at p<0.05.

Results:

There were no differences between the groups on patient age, sex, ethnicity, or CIT. The median graft survival (Figure 1) was superior in the ID-LDRT (16 years, p=0.008).

Graft survival was not significantly different in the other 3 groups; 5M-LDRT (10.9 years), 6M-CRT (8.5 years), and 5M-CRT (10.1 years). There was no significant difference in patient survival.

Conclusion:

In this analysis, there was no incremental graft survival benefit of 6M CRT over the next-best category, the 5M-CRT. ID-LDRT (siblings) enjoyed a 5 year median graft survival increase over their 1 HLA mismatched controls. Our data suggests that non-HLA and minor HLA antigens impact graft loss. These results need to be confirmed by analyzing national data, and correlated to immunosuppression exposure.

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